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Digestive Diseases (Basel, Switzerland) 2022An increase in the incidence of duodenal adenocarcinoma has been recently reported. However, little is known about the risk factors for duodenal adenocarcinoma, which...
INTRODUCTION
An increase in the incidence of duodenal adenocarcinoma has been recently reported. However, little is known about the risk factors for duodenal adenocarcinoma, which are important for screening purposes. We, therefore, aimed to conduct a systematic review to identify risk factors for non-ampullary duodenal adenocarcinoma.
METHODS
A medical literature search was performed using electronic databases, including PubMed, Cochrane Library, Japan Medical Abstracts Society, and Web of Science. Studies that assessed the association between dietary habits, lifestyle behaviors, comorbidities, and non-ampullary duodenal adenocarcinoma were extracted. The Newcastle-Ottawa Scale was used to assess the risk of bias in individual studies, and the Grading of Recommendations, Assessment, Development, and Evaluations approach was used to assess the quality of evidence across studies included in this review.
RESULTS
Out of 1,244 screened articles, 10 were finally selected for qualitative synthesis. In the general population, no consistent risk factors were identified except for Helicobacter pylori positivity, which was considered a risk factor in 2 studies, but the quality of evidence was considered very low because of the high risk of bias. In patients with familial adenomatous polyposis (FAP), Spigelman stage IV at initial endoscopy was considered a consistent risk factor in 3 studies.
CONCLUSIONS
There are currently limited data regarding risk factors for non-ampullary duodenal adenocarcinoma, and no conclusive risk factors were identified in the general population. However, in patients with FAP, Spigelman stage IV was identified as a consistent risk factor. Further studies are needed to improve diagnosis and support effective clinical management of this malignancy.
Topics: Adenocarcinoma; Adenomatous Polyposis Coli; Duodenal Neoplasms; Duodenum; Humans; Risk Factors
PubMed: 34000722
DOI: 10.1159/000516561 -
Korean Journal of Radiology 2015This pictorial review aims to illustrate the magnetic resonance imaging (MRI) findings and presentation patterns of anatomical variations and various benign and... (Review)
Review
This pictorial review aims to illustrate the magnetic resonance imaging (MRI) findings and presentation patterns of anatomical variations and various benign and malignant pathologies of the duodenum, including sphincter contraction, major papilla variation, prominent papilla, diverticulum, annular pancreas, duplication cysts, choledochocele, duodenal wall thickening secondary to acute pancreatitis, postbulbar stenosis, celiac disease, fistula, choledochoduodenostomy, external compression, polyps, Peutz-Jeghers syndrome, ampullary carcinoma and adenocarcinoma. MRI is a useful imaging tool for demonstrating duodenal pathology and its anatomic relationships with adjacent organs, which is critical for establishing correct diagnosis and planning appropriate treatment, especially for surgery.
Topics: Ampulla of Vater; Choledochal Cyst; Diverticulum; Duodenal Diseases; Duodenum; Humans; Magnetic Resonance Imaging; Pancreas; Pancreatic Diseases; Radiography
PubMed: 26576112
DOI: 10.3348/kjr.2015.16.6.1240 -
Annali Italiani Di Chirurgia 2021In this study, we aimed to evaluate patients who underwent curative surgical treatment for primary duodenal adenocarcinoma and to present our experience.
AIM
In this study, we aimed to evaluate patients who underwent curative surgical treatment for primary duodenal adenocarcinoma and to present our experience.
MATERIAL AND METHODS
Patients diagnosed with primary duodenal adenocarcinoma between 2006 and 2018 participated in the study. The demographic and clinical characteristics of the patients, details of the operation, pathological features of the tumors, short- and long-term follow-up results, and mean survival were evaluated retrospectively.
RESULTS
Nine patients with a mean age of 54.7 participated in the study. 55% of the patients were male. The most common presenting symptom was abdominal pain (n: 6; 67%). The most common tumor localization was D2-3 (n: 7; 78%), and the most common surgical operation was pancreaticoduodenectomy (n: 7; 78%). There were no intraoperative complications in any patient. The mean tumor diameter was 3.5 cm. The mean number of lymph nodes dissected was 8.3 and the mean number of metastatic lymph nodes was 2. The most common postoperative complication was pancreatic fistula (n: 3; 33%). The mean length of stay was 21.8 days. One patient developed septic shock and mortality happened within the 30-day period. The most common cause of unplanned admission to the hospital within 90 days was wound infection (n: 2; 22%). One patient developed local recurrence and two patients had systemic metastasis. We found an average survival of 40 months.
DISCUSSION
Pancreaticoduodenectomy is the most common approach in its curative surgery and it has a long survival despite the high postoperative complication rate. We recommend radical resection in the surgical treatment of primary duodenal adenocarcinoma.
KEY WORDS
Adenocarcinoma, Duodenum, Pancreaticoduodenectomy.
Topics: Adenocarcinoma; Duodenal Neoplasms; Duodenum; Female; Humans; Male; Neoplasm Recurrence, Local; Pancreatic Neoplasms; Pancreaticoduodenectomy; Retrospective Studies; Treatment Outcome
PubMed: 33746122
DOI: No ID Found -
Der Chirurg; Zeitschrift Fur Alle... Sep 2021Periampullary neoplasms are a heterogeneous group of different tumor entities arising from the periampullary region, of which pancreatic ductal adenocarcinoma (PDAC) is... (Review)
Review
Periampullary neoplasms are a heterogeneous group of different tumor entities arising from the periampullary region, of which pancreatic ductal adenocarcinoma (PDAC) is the most common subgroup with 60-70%. As typical for pancreatic adenocarcinomas, periampullary pancreatic cancer is characterized by an aggressive growth and early systemic progression. Due to the anatomical location in close relationship to the papilla of Vater symptoms occur at an earlier stage of the disease, so that treatment options and prognosis are overall more favorable compared to pancreatic carcinomas at other locations. Nevertheless, the principles of treatment for periampullary pancreatic cancer are not substantially different from the standards for pancreatic cancer at other locations. A potentially curative approach for non-metastatic periampullary pancreatic cancer is a multimodal therapy concept, which includes partial pancreatoduodenectomy as a radical oncological resection in combination with a systemic adjuvant chemotherapy. As a result, long-term survival can be achieved in patients with favorable prognostic factors. In addition, with the continous development of surgery and systemic treatment potentially curative treatment concepts for advanced initially nonresectable tumors were also established, after completion of neoadjuvant treatment. This article presents the current surgical principles of a radical oncological resection for periampullary pancreatic cancer in the context of a multimodal treatment concept with an outlook for future developments of treatment.
Topics: Adenocarcinoma; Ampulla of Vater; Common Bile Duct Neoplasms; Duodenal Neoplasms; Humans; Pancreatic Neoplasms
PubMed: 34259884
DOI: 10.1007/s00104-021-01462-1 -
Abdominal Radiology (New York) Feb 2018Despite advances in oncologic and imaging technology, pancreatic ductal adenocarcinoma remains a highly deadly disease. The only curative option, pancreaticoduodenectomy... (Review)
Review
Despite advances in oncologic and imaging technology, pancreatic ductal adenocarcinoma remains a highly deadly disease. The only curative option, pancreaticoduodenectomy or pancreatectomy, carries a significant morbidity. Current imaging plays a role in pre-operative staging to determine the probability of achieve disease-free margins. However, a small but not insignificant number of pancreatic cancers have a relatively higher aggressive biology, despite being resectable based on traditional criteria. Recently, imaging biomarkers that serve as a surrogate for tumors with such aggressive phenotype have been described. These include duodenal invasion and extrapancreatic perineural invasion. This review will focus on the former highlighting the summary of literature supporting duodenal invasion as a surrogate for aggressive disease as well as review its MDCT imaging features.
Topics: Adenocarcinoma; Duodenum; Humans; Neoplasm Invasiveness; Neoplasm Staging; Pancreatic Neoplasms; Phenotype; Prognosis; Tomography, X-Ray Computed
PubMed: 28770287
DOI: 10.1007/s00261-017-1271-8 -
World Journal of Surgical Oncology Mar 2023The most recent edition of the American Joint Committee on Cancer Staging Manual (AJCC, 8th edition) relies only on tumor size for staging resectable pancreatic... (Review)
Review
OBJECTIVE
The most recent edition of the American Joint Committee on Cancer Staging Manual (AJCC, 8th edition) relies only on tumor size for staging resectable pancreatic adenocarcinoma, and the presence of duodenal wall invasion (DWI) no longer has an impact on staging. However, very few studies have evaluated its significance. In this study, we aim to evaluate the prognostic significance of DWI in pancreatic adenocarcinoma.
METHODS
We reviewed 97 consecutive internal cases of resected pancreatic head ductal adenocarcinoma, and clinicopathologic parameters were recorded. All cases were staged according to the 8th edition of AJCC, and the patients were divided into two groups based on the presence or absence of DWI.
RESULTS
Out of our 97 cases, 53 patients had DWI (55%). In univariate analysis, DWI was significantly associated with lymphovascular invasion and lymph node metastasis (AJCC 8th edition pN stage). In univariate analysis of overall survival, age > 60, absence of DWI, and African American race were associated with worse overall survival. In multivariate analysis, age > 60, absence of DWI, and African American race were associated with worse progression-free survival and overall survival.
CONCLUSION
Although DWI is associated with lymph node metastasis, it is not associated with inferior disease-free/overall survival.
Topics: Humans; Pancreatic Neoplasms; Prognosis; Adenocarcinoma; Lymphatic Metastasis; Carcinoma, Pancreatic Ductal
PubMed: 36872330
DOI: 10.1186/s12957-023-02962-6 -
Current Treatment Options in Oncology Sep 2021ACs are rare tumors, and thus, there is a lack of prospective trials supporting treatment decisions. Moreover, although anatomically uniform, ACs comprise of... (Review)
Review
ACs are rare tumors, and thus, there is a lack of prospective trials supporting treatment decisions. Moreover, although anatomically uniform, ACs comprise of biologically distinct entities, depending on what cell type they arise from. This makes the interpretation of limited data even more challenging. Overall, the clinical outcomes of patients with AC are better than those with pancreatic cancer. However, recurrence rates remain high after curative resection. Despite the absence of definitive evidence, we believe that these high recurrence rates are a rational justification for consideration of adjuvant therapy in resected disease, and therapy selection should take tumor biology, stage, resection margins, as well as patient comorbidities and performance status into account. Largely extrapolating from pancreas cancer, we recommend consideration of adjuvant chemotherapy with 6 months of dose-modified FOLFIRINOX in fit patients with pancreatobiliary subtype tumors. Alternative regimens include gemcitabine in combination with capecitabine. If chemoradiotherapy is being added, 6 weeks of radiotherapy in conjunction with 5-FU or capecitabine can be considered. For intestinal subtypes, we recommend 3-6 months of adjuvant FOLFOX. Future studies are needed to evaluate the role of contemporary, multi-agent chemotherapy and chemoradiotherapy in patients with resected and advanced ampullary adenocarcinoma. However, the logistics of performing large randomized trials in patients with a rare cancer is challenging, and the data collection, even in a carefully designed study, would likely take many years. As such, relying on data from basket trials and retrospective analysis will likely serve as guidance for treatment decisions in the near future. Treatment of metastatic disease should employ regimens that are typically used to treat pancreas cancer for tumors of pancreatobiliary subtype and 5-FU-based regimens for intestinal subtypes. Studies specific for patients with advanced AC are much needed. Molecular testing using next-generation sequencing and testing for microsatellite instability (MSI) should be performed on all tumors. We now have disease agnostic options based on these results. Pembrolizumab is approved for MSI-H tumors and tumors with high tumor mutational burden regardless of the primary site. Larotrectinib is approved for tumors with NTRK fusions. At a time when numerous therapeutic agents are in development, for example, those targeting specific K-RAS alterations or NRG fusions, identifying molecular aberrations can significantly impact patient outcomes as well as provide further insights into the biology of disease. In addition, based on recent data suggesting a significant prevalence of germline alterations in patients with ampullary tumors, referral to genetics counselors and germline testing is warranted in a significant proportion of patients with AC.
Topics: Adenocarcinoma; Ampulla of Vater; Clinical Decision-Making; Combined Modality Therapy; Common Bile Duct Neoplasms; Disease Management; Disease Susceptibility; Humans; Prognosis; Treatment Outcome
PubMed: 34586537
DOI: 10.1007/s11864-021-00894-5 -
Journal of Gastrointestinal Surgery :... Nov 2023Segmental resections of the duodenum are uncommonly performed and are technically challenging due to intimate relationships with the biliary tree, pancreas, and superior...
BACKGROUND
Segmental resections of the duodenum are uncommonly performed and are technically challenging due to intimate relationships with the biliary tree, pancreas, and superior mesenteric vessels. The objective of this study was to assess indications, operative strategy, and outcomes of duodenal resections and to advocate that this form of resection deserves its own unique Current Procedural Terminology (CPT) and Relative Value Unit (RVU) structure.
METHODS
Patients undergoing isolated and partial duodenal resection from 2008-2023 at University of Tennessee Health Science Center affiliated hospitals were retrospectively reviewed. Factors examined included clinical presentation, diagnostic evaluation, operative time, and technique, 90-day morbidity and mortality, and pathologic and survival outcomes.
RESULTS
Thirty-one patients were identified with majority female and a median age of 61. Diagnostic studies included computed tomography and upper (including push) endoscopy. Reconstruction most often involved side-to-side duodenojejunostomy following distal duodenal resection. Intraoperative evaluation (IOE) of the biliary tree was utilized to assess and protect pancreaticobiliary structures in eleven patients. Median operative time was 206 min, increasing to 236 min when IOE was necessary. Procedure-related morbidity was 23% with one 90-day mortality. Median postoperative length of stay was 9 days. Pathology included benign adenoma, adenocarcinoma, GIST, neuroendocrine neoplasms, and erosive metastatic deposit.
CONCLUSION
Duodenal resections can be effectively employed to safely address diverse pathologies. These procedures are characterized by long operative times, extended hospital stays, and an incidence of postoperative complications that mimics that of pancreatic resection. This work highlights the need for modification to the CPT system to accurately define these distinct procedures for future research endeavors and development of a more accurate valuation unit.
Topics: Humans; Duodenal Neoplasms; Retrospective Studies; Duodenum; Pancreas; Pancreatectomy
PubMed: 37749459
DOI: 10.1007/s11605-023-05837-z -
Diseases of the Colon and Rectum Nov 2017Duodenal polyposis is a manifestation of adenomatous polyposis that predisposes to duodenal or ampullary adenocarcinoma. Duodenal polyposis is monitored by upper GI...
BACKGROUND
Duodenal polyposis is a manifestation of adenomatous polyposis that predisposes to duodenal or ampullary adenocarcinoma. Duodenal polyposis is monitored by upper GI endoscopies and may require iterative resections and prophylactic radical surgical treatment when malignancy is threatening.
OBJECTIVE
The purpose of this study was to evaluate severity scoring for surveillance and treatment in a large series of duodenal polyposis.
DESIGN
From 1982 to 2014, every patient surveyed by upper GI endoscopies for duodenal polyposis was included.
SETTINGS
The study was conducted at a single tertiary care center.
PATIENTS
We performed 1912 upper GI endoscopies in 437 patients (median = 3; interquartile range, 2-6 endoscopies).
MAIN OUTCOME MEASURES
Conservative treatment was performed in 103 patients (159 endoscopic and 17 surgical resections), whereas radical surgical treatment (Whipple procedure or duodenectomy) was required in 52 (median age, 47.5 y; range, 43.0-57.3 y) because of high-grade dysplasia or unresectable lesions.
RESULTS
Genes involved were APC (n = 274; 62.7%) and MUTYH (n = 21; 4.8%). First upper GI endoscopies (median age, 32 y; range, 21-44 y) revealed duodenal polyposis in 190 (43.5%). Rates of low-grade dysplasia, high-grade dysplasia, and duodenal or ampulary adenocarcinoma at 5 years were 65% (range, 61.7%-66.9%), 12.1% (range, 10.3%-13.9%), and 2.4% (range, 1.5%-3.3%), whereas 10-year rates were 75.8% (range, 73.1%-78.5%), 20.8% (range, 18.2%-23.4%), and 5.4% (range, 3.8%-7.0%). The rate of ampullary abnormalities rose during surveillance from 18.3% at the first upper GI endoscopies to 47.4% at the fourth. Predictive factors for high-grade dysplasia were age at first upper GI endoscopy, type and age of colorectal surgery, Spigelman score, presence of an ampullary abnormality, and number of endoscopic treatments. In multivariate analysis, only age at first upper GI endoscopy and presence of an ampullary abnormality were independent predictive factors. Histologic analysis after radical surgical treatment showed high-grade dysplasia in 30 patients and duodenal or ampulary adenocarcinoma in 11 (4 patients had lymph node involvement).
LIMITATIONS
The study was limited by its retrospective analysis of a prospective database.
CONCLUSIONS
More than 20% of patients developed high-grade dysplasia with duodenal polyposis after 10 years. Iterative endoscopic resections allowed extended control, but surgery remained necessary in 12% of the patients and happened too late in many cases; 20% of those operated had developed duodenal or ampulary adenocarcinoma, whereas 8% exhibited malignancy with lymph node involvement. The trigger for prophylactic surgery required a more accurate predictive score leading to closer endoscopic surveillance. Modifying the Spigelman score by accounting for ampullary abnormalities should be considered as a means to increase compliance with closer endoscopic follow-up in high-risk patients. See Video Abstract at http://links.lww.com/DCR/A430.
Topics: Adenomatous Polyposis Coli; Aftercare; Duodenal Neoplasms; Duodenum; Endoscopy, Gastrointestinal; Humans; Neoplasm Staging
PubMed: 28991077
DOI: 10.1097/DCR.0000000000000903 -
Abdominal Radiology (New York) Jul 2023Given its crucial location at the crossroads of the gastrointestinal tract, the hepatobiliary system and the splanchnic vessels, the duodenum can be affected by a wide... (Review)
Review
Given its crucial location at the crossroads of the gastrointestinal tract, the hepatobiliary system and the splanchnic vessels, the duodenum can be affected by a wide spectrum of abnormalities. Computed tomography and magnetic resonance imaging, in conjunction with endoscopy, are often performed to evaluate these conditions, and several duodenal pathologies can be identified on fluoroscopic studies. Since many conditions affecting this organ are asymptomatic, the role of imaging cannot be overemphasized. In this article we will review the imaging features of many conditions affecting the duodenum, focusing on cross-sectional imaging studies, including congenital malformations, such as annular pancreas and intestinal malrotation; vascular pathologies, such as superior mesenteric artery syndrome; inflammatory and infectious conditions; trauma; neoplasms and iatrogenic complications. Because of the complexity of the duodenum, familiarity with the duodenal anatomy and physiology as well as the imaging features of the plethora of conditions affecting this organ is crucial to differentiate those conditions that could be managed medically from the ones that require intervention.
Topics: Humans; Duodenum; Tomography, X-Ray Computed; Magnetic Resonance Imaging; Neoplasms; Pancreatic Diseases
PubMed: 37099183
DOI: 10.1007/s00261-023-03909-x