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The American Journal of Surgical... Dec 2021Nonampullary duodenal adenomas (NADAs) develop sporadically or in the setting of a hereditary syndrome such as familial adenomatous polyposis (FAP). Although they are...
Nonampullary Duodenal Adenomas in Familial Adenomatous Polyposis and Sporadic Patients Lack the DNA Content Abnormality That Is Characteristic of the Adenoma-Carcinoma Sequence Involved in the Development of Other Gastrointestinal Malignancies.
Nonampullary duodenal adenomas (NADAs) develop sporadically or in the setting of a hereditary syndrome such as familial adenomatous polyposis (FAP). Although they are thought to progress into duodenal adenocarcinomas via an adenoma to carcinoma sequence similar to colorectal cancer, limited data suggested that they may be biologically dissimilar to colorectal adenomas. The clinicopathologic features of 71 patients diagnosed with NADAs (37 FAP and 34 sporadic) were analyzed. From the 71 patients, 89 NADA biopsies (42 FAP and 47 sporadic) were evaluated by DNA flow cytometry. Eighty-two samples showed low-grade dysplasia, and 7 demonstrated high-grade dysplasia (HGD). Twenty-one low-grade adenomas of the ileal pouch (n=19) and jejunum (n=2) from 15 FAP patients who underwent total proctocolectomy were also analyzed by DNA flow cytometry. The FAP patients were more likely to be younger (mean: 28 y) and have multifocal disease (92%) than the sporadic patients (66 y and 24%, respectively) (P<0.001). Most NADAs presented as polypoid lesions (87%) in the duodenal bulb and/or second portion of the duodenum (94%). Sporadic NADAs (mean: 2.4 cm) were significantly larger than FAP-related NADAs (1.3 cm) (P=0.005). Three (4%) patients (2 sporadic and 1 FAP) had high-grade NADAs at the first endoscopy, while the remaining 68 (96%) patients had low-grade dysplasia. Two additional sporadic and 1 FAP patients developed HGD on follow-up. Although the overall detection rate of advanced neoplasia (either HGD or adenocarcinoma) was similar between the FAP (n=5; 14%) and sporadic groups (n=4; 12%) (P=1.000), 3 FAP patients (all with Spigelman stage III to IV) developed adenocarcinoma in the duodenum (n=2) or in the ileal pouch (n=1) within a mean follow-up time of 76 months, while no adenocarcinoma was found in the sporadic group. Of the 37 FAP patients, 29 (78%) had a history of total proctocolectomy, and 15 (52%) developed low-grade adenomas in the ileal pouch with (n=2) or without (n=13) jejunal involvement (vs. 0% in the sporadic patients, P<0.001). All 15 patients had ≥Spigelman stage II. Aneuploidy was detected in only 1 (1%) sporadic NADA with HGD, whereas the remaining 109 duodenal, ileal pouch, and jejunal adenomas showed normal DNA content. The overall 3-, 9-, and 15-year detection rates of adenocarcinoma (in the duodenum and ileal pouch) in all NADA patients were 1.4%, 7.2%, and 18.8%, respectively. Three-, 9-, and 15-year detection rates of adenocarcinoma in the FAP patients were 2.7%, 9.7%, and 22.6%, respectively, while these rates remained at 0% in the sporadic patients. In conclusion, FAP-related NADAs have distinct clinicopathologic features compared with their sporadic counterpart. However, the vast majority of both FAP-related and sporadic NADAs (99%) lack the DNA content abnormality that is characteristic of the typical adenoma-carcinoma sequence involved in other gastrointestinal carcinogenesis. Although adenocarcinoma is more likely to develop in FAP patients with a high adenoma burden, probably due to the higher likelihood that some advanced lesions are missed endoscopically, FAP-related and sporadic NADAs may have a comparable risk of developing advanced neoplasia on a per-adenoma basis.
Topics: Adenocarcinoma; Adenomatous Polyposis Coli; Adolescent; Adult; Aged; Aged, 80 and over; Aneuploidy; Biopsy; Child; DNA, Neoplasm; Disease Progression; Duodenal Neoplasms; Female; Flow Cytometry; Humans; Male; Middle Aged; Neoplasm Grading; Risk Assessment; Risk Factors; Young Adult
PubMed: 34138799
DOI: 10.1097/PAS.0000000000001754 -
Gastrointestinal Endoscopy Jul 2024
Topics: Humans; Lipoma; Duodenal Neoplasms; Gastrointestinal Hemorrhage; Male; Female; Middle Aged
PubMed: 38151135
DOI: 10.1016/j.gie.2023.12.030 -
Digestive Diseases and Sciences Nov 2017The duodenal gastrointestinal stromal tumors (GISTs) are an extremely rare subset of GISTs. The optimal surgical procedure remains not well defined. (Comparative Study)
Comparative Study
BACKGROUND
The duodenal gastrointestinal stromal tumors (GISTs) are an extremely rare subset of GISTs. The optimal surgical procedure remains not well defined.
AIMS
We assessed the surgical approach and long-term outcomes of patients with duodenal GISTs who underwent limited resection (LR) versus pancreaticoduodenectomy (PD).
METHODS
From November 2005 to January 2016, 64 consecutive patients with duodenal GISTs in a single center were retrospectively analyzed. Overall survival (OS), recurrence-free survival (RFS), and perioperative outcomes were analyzed according to the different surgical type.
RESULTS
A total of 41 patients (64.1%) underwent LR, while 23 patients (35.9%) underwent PD. All patients had negative surgical margins (R0). Median tumor size was larger for PD (6 cm) versus LR (4 cm) (P = 0.041). PD also had more complications than LR (PD, 69.6 vs. LR, 31.7%) (P = 0.002). The 3-year and 5-year RFS was 62.9 and 44.3%, respectively. The 3-year and 5-year OS was 85.7 and 59.5%, respectively. The multivariate analysis demonstrated the only unfavorable predictive factor was tumor size >5 cm for RFS and OS. Although the complication rate in the PD group was higher than in the LR group, OS and RFS were not affected by the complication (P = 0.492 for OS, P = 0.512 for RFS). PD versus LR was not associated with RFS and OS. Adjuvant imatinib mesylate (IM) did not improve the survival of the patients after operation.
CONCLUSIONS
Survival of duodenal GISTs is mainly dependent on tumor biology rather than surgical procedure. LR should be the surgical procedure of choice for duodenal GISTs when technically feasible and no anatomical constrains. LR shows comparable survival and lower risk of postoperative complications compared by PD. The administration of IM both as adjuvant and neoadjuvant therapy for duodenal GISTs needs large population and prospective study to evaluate its effect.
Topics: Adult; Aged; Chi-Square Distribution; China; Disease Progression; Disease-Free Survival; Duodenal Neoplasms; Female; Gastrointestinal Stromal Tumors; Humans; Kaplan-Meier Estimate; Male; Margins of Excision; Middle Aged; Mitotic Index; Multivariate Analysis; Neoplasm Recurrence, Local; Pancreaticoduodenectomy; Proportional Hazards Models; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; Tumor Burden
PubMed: 28914399
DOI: 10.1007/s10620-017-4742-4 -
Updates in Surgery Dec 2020Infra-ampullary duodenal lesions are rare and surgical management is controversial. Reconstruction after resection is usually performed by end-to-end or end-to-side...
Infra-ampullary duodenal lesions are rare and surgical management is controversial. Reconstruction after resection is usually performed by end-to-end or end-to-side duodenojejunostomy. The goal was to analyze our experience, perioperative management, and results after side-to-side duodenojejunostomy. Therefore, we retrospectively evaluated short- and long-term results of surgical resections of third and fourth duodenal portions for several kinds of lesions and reconstruction through duodenojejunostomy performed in our facilities between January 2012 and December 2018. In total, 12 patients were selected for our study, six were male. The median age was 66.3 (IQR: 77.3-59.4). Lesion classification was as follows: 6 cases (50%) of duodenal adenocarcinoma, 4 cases (33.3%) of gastrointestinal stromal tumors (GISTs), and 2 cases (16.7%) of benign pathology. The most frequent clinical presentation was obstruction with vomiting. The surgical technique of choice was resection of third and fourth duodenal portions with a segment of proximal jejunum. Digestive continuity was restored through side-to-side duodenojejunostomy in 11 cases (91.6%). The median operation time was 182.5 min (IQR 237.5-136.3 min). Nine of the 12 patients (75%) did not receive intra- or postoperative blood transfusions. Six patients (50%) experienced complications during post-op. Four of them (33%) experienced major complications (Clavien-Dindo > IIIa) and three required re-op. The median follow-up was 58.3 (95% CI 15-101.5) months. Of the 11 patients with long-term follow-up, 10 have remained asymptomatic during follow-up. The average disease-free survival (DFS) was 43.1 months for adenocarcinoma, and 93 months for GIST. Based on the results of our series, although small, pancreas-sparing duodenectomy could be considered a feasible and safe technique with adequate oncological results. Side-to-side duodenojejunostomy appears to be a safe technique, is easy to perform, and has good functional outcomes. More studies with a larger number of patients are necessary to confirm these findings.
Topics: Adenocarcinoma; Aged; Blood Transfusion; Disease-Free Survival; Duodenal Diseases; Duodenal Neoplasms; Duodenum; Feasibility Studies; Female; Follow-Up Studies; Gastrointestinal Stromal Tumors; Humans; Jejunostomy; Male; Middle Aged; Operative Time; Organ Sparing Treatments; Pancreas; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 32504267
DOI: 10.1007/s13304-020-00823-5 -
Future Oncology (London, England) Mar 2022This study aimed to develop a predictive model for patients with duodenal carcinoma. Duodenal carcinoma patients from the Surveillance, Epidemiology, and End Results...
This study aimed to develop a predictive model for patients with duodenal carcinoma. Duodenal carcinoma patients from the Surveillance, Epidemiology, and End Results database (2010-2015) and the First Affiliated Hospital of Nanchang University (2010-2021) were enrolled. A nomogram was constructed according to least absolute shrinkage and selection operator regression analysis, the Akaike information criterion approach and Cox regression analysis. Five independent prognostic factors were significantly associated with the prognosis of the duodenal carcinoma patients. A nomogram was constructed with a C-index in the training and validation cohorts of 0.671 (95% CI: 0.578-0.716) and 0.662 (95% CI: 0.529-0.773), respectively. The established nomogram model provided visualization of the risk of each prognostic factor.
Topics: China; Duodenal Neoplasms; Female; Humans; Kaplan-Meier Estimate; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Grading; Neoplasm Staging; Nomograms; Prognosis; Risk Assessment; SEER Program; United States
PubMed: 35114801
DOI: 10.2217/fon-2021-0622 -
European Journal of Surgical Oncology :... Oct 2019Gastrointestinal stromal tumors (GISTs), with a primary occurrence in the duodenum and proximal jejunum, are rare and treatment is poorly understood. This study aimed to...
INTRODUCTION
Gastrointestinal stromal tumors (GISTs), with a primary occurrence in the duodenum and proximal jejunum, are rare and treatment is poorly understood. This study aimed to evaluate the main factors influencing the prognosis of GIST resection in this complex anatomical structure.
MATERIALS AND METHODS
This retrospective study included 47 patients who underwent surgery for primary GIST of the duodenum (20) and proximal jejunum (27) between 2012 and 2017. Perioperative clinical data as well as relapse and survival information were collected.
RESULTS
All patients underwent negative margin resection (R0) of duodenal and proximal jejunum GISTs. Complications occurred more frequently in treatment of duodenal GISTs than proximal jejunum GISTs (p = 0.003). GISTs in D3 (the 3rd portion of duodenum) were related to larger tumor size (p = 0.001), higher probability of severe complication rate (p = 0.042), longer hospital stays (p = 0.023) and fasting time (p = 0.020). More complications were found for patients with digestive reconstruction than limited resection (p = 0.010). Additionally, patients with a tumor mass larger than 5 cm or a mitotic index greater than 5 mitoses/50 HPFs showed poorer therapeutic outcomes. The 1- and 3-year overall survival was 97.9% and 86.1%, respectively and were not influenced by operation type (p = 0.061) or GIST position (p = 0.447).
CONCLUSION
With negative operational margins, limited resection is a safe and feasible procedure for duodenal and proximal jejunum GIST patients and unnecessary digestive reconstruction should be avoided. Considering the severe complication rate, resection for GISTs in D3 should be performed with care.
Topics: Adult; Aged; Aged, 80 and over; China; Digestive System Surgical Procedures; Duodenal Neoplasms; Duodenum; Female; Follow-Up Studies; Gastrointestinal Stromal Tumors; Humans; Incidence; Jejunal Neoplasms; Jejunum; Male; Middle Aged; Neoplasm Staging; Postoperative Complications; Retrospective Studies; Survival Rate; Young Adult
PubMed: 31085027
DOI: 10.1016/j.ejso.2019.05.002 -
Journal of Clinical Pathology Jan 2016For many years, it was generally accepted that the vast majority of the colorectal carcinomas (CRCs) evolved from conventional adenomas, via the adenoma-carcinoma... (Review)
Review
For many years, it was generally accepted that the vast majority of the colorectal carcinomas (CRCs) evolved from conventional adenomas, via the adenoma-carcinoma sequence. More recently, serrated colorectal polyps (hyperplastic polyps, sessile serrated polyps and traditional serrated adenomas (TSAs)) have emerged as an alternative pathway of colorectal carcinogenesis. It has been estimated that about 30% of the CRC progress via the serrated pathway. Recently, TSAs were also detected in the upper digestive tract. In this work, we review the literature on TSA in the oesophagus, the stomach, the duodenum, the pancreatic main duct and the gallbladder. The review indicated that 53.4% (n=39) out of the 73 TSA of the upper digestive tract now in record showed a simultaneously growing invasive carcinoma. As a corollary, TSAs of the upper digestive tract are aggressive adenomas that should be radically excised, either endoscopically or surgically, to rule out the possibility of a synchronously growing invasive adenocarcinoma or to prevent cancer progression. The present findings substantiate a TSA pathway of carcinogenesis in the upper digestive tract.
Topics: Adenoma; Biomarkers, Tumor; Biopsy; Duodenal Neoplasms; Esophageal Neoplasms; Gallbladder; Humans; Immunohistochemistry; Neoplasm Invasiveness; Pancreatic Neoplasms; Prognosis; Stomach Neoplasms
PubMed: 26468393
DOI: 10.1136/jclinpath-2015-203258 -
International Journal of Surgery... Jul 2023Duodenal neuroendocrine tumors (D-NETs) are uncommon. The surgical treatment for D-NETs was in debate. Laparoscopic and endoscopic cooperative surgery (LECS) is a...
BACKGROUND
Duodenal neuroendocrine tumors (D-NETs) are uncommon. The surgical treatment for D-NETs was in debate. Laparoscopic and endoscopic cooperative surgery (LECS) is a promising approach for treating gastrointestinal tumors. The study aimed to evaluate the feasibility and safety of LECS for D-NETs. Meanwhile, the authors described the details of the LECS technique.
METHODS
All patients diagnosed with D-NETs underwent LECS between September 2018 and April 2022 were retrospectively reviewed. The endoscopic procedures were performed with endoscopic full-thickness resection. The defect was manually closed under the surveillance of the laparoscopy.
RESULTS
A total of seven patients were enrolled, including three men and four women. The median age was 58 years (ranging from 39-65). Four tumors were located in the bulb and three in the second portion. All cases were diagnosed as NET with grade G1. The tumor depth was pT1 in two cases and pT2 in five cases. The median specimen size and the tumor size were 22 mm (ranging from 10-30) and 8.0 mm (ranging from 2.3-13.0), respectively. En-bloc resection and curative resection rates are 100 and 85.7%, respectively. There were no severe complications. Until 1 June 2022, there was no recurrence. The median follow-up was 9.5 months (range, 1.4-45.1).
CONCLUSIONS
LECS with endoscopic full-thickness resection is a reliable surgical procedure. The minimally invasive advantages of LECS enable more individualized treatment options for a specific group. Limited by the length of observation, the long-term performance of LECS for D-NETs requires additional investigation.
Topics: Male; Humans; Female; Middle Aged; Neuroendocrine Tumors; Retrospective Studies; Laparoscopy; Duodenal Neoplasms
PubMed: 37300883
DOI: 10.1097/JS9.0000000000000440 -
The American Journal of Gastroenterology Dec 2022
Topics: Humans; Lymphoma, Follicular; Duodenal Neoplasms
PubMed: 35971212
DOI: 10.14309/ajg.0000000000001952 -
Revista Espanola de Enfermedades... May 2022Endoscopic treatment for duodenal neuroendocrine tumors (d-NET) is technically challenging due to the anatomical characteristics of the duodenum, and is associated with...
Endoscopic treatment for duodenal neuroendocrine tumors (d-NET) is technically challenging due to the anatomical characteristics of the duodenum, and is associated with a high risk of perforation and a positive vertical margin because of infiltration into the submucosa. We herein present a case of d-NET that was successfully removed by over-the-scope clip (OTSC)-assisted endoscopic resection. OTSC-assisted endoscopic resection is a safe and reliable treatment method that enables deep submucosal resection in a short time without the risk of perforation.
Topics: Duodenal Neoplasms; Endoscopy, Gastrointestinal; Female; Humans; Intestinal Neoplasms; Middle Aged; Neuroendocrine Tumors; Pancreatic Neoplasms; Stomach Neoplasms
PubMed: 34470453
DOI: 10.17235/reed.2021.8232/2021