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Hawai'i Journal of Health & Social... Oct 2019Primary small bowel neoplasms at the ligament of Treitz are extremely rare and require advanced surgical technique for extirpation. The insidious onset of disease allows...
Primary small bowel neoplasms at the ligament of Treitz are extremely rare and require advanced surgical technique for extirpation. The insidious onset of disease allows for a delayed presentation, often accompanied by moderate-size growth of the neoplasm, causing intestinal bleeding and bowel obstruction. The partial retroperitoneal location of these tumors pose a unique challenge for surgical resection. We present an unusual case of a primary small bowel adenocarcinoma at the Ligament of Treitz, requiring segmental resection of the fourth portion of the duodenum plus the proximal jejunum.
Topics: Adenocarcinoma; Anastomosis, Surgical; Duodenal Neoplasms; Humans; Jejunal Neoplasms; Male; Middle Aged; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 31633113
DOI: No ID Found -
Surgical Endoscopy Dec 2010Premalignant duodenal lesions such as adenomas are rare. Surgical resection has been the standard approach to the treatment of these lesions. Endoscopic resection of...
BACKGROUND
Premalignant duodenal lesions such as adenomas are rare. Surgical resection has been the standard approach to the treatment of these lesions. Endoscopic resection of superficial premalignant or malignant lesions of the gastrointestinal tract is used with increasing frequency. This study aimed to evaluate the safety and efficacy of endoscopic resection of duodenal neoplasms.
METHODS
Patients with nonampullary duodenal adenomas or duodenal adenocarcinomas without familial polyposis syndrome between August 2002 and February 2009 were retrospectively analyzed. Data including location and size, technique used for the endoscopic resection, complications, and follow-up evaluation of the lesions were reviewed.
RESULTS
The study enrolled 24 patients with duodenal neoplasms. Of these patients, 23 had duodenal adenomas and 1 had an adenocarcinoma confined to the mucosa. The mean age of the patients was 57 years (range, 40-82). In terms of location, 12 lesions (50%, 12/24) were found in the second portion of the duodenum, and 11 (45.8%, 11/24) were found in the first portion. Tubular adenomas were the most common type (17/24, 70.8%). There were four cases of the villotubular type and three of the villous type. Conventional endoscopic mucosal resection (EMR) was performed for 19 patients, EMR with ligation (EMR-L) for 3 patients, and snare polypectomy for 2 patients. Complete resection was achieved for 87.5% (21/24) of the patients, and the recurrence rate was 8.3% (2/24). All the complications were intraprocedural bleeding (n = 7), with no occurrence of perforation or infection. During a median follow-up period of 6 months (range, 3-36 months), recurrence of the duodenal neoplasm was observed in two cases. There was no procedure-related mortality.
CONCLUSIONS
Endoscopic resection of duodenal neoplasms was safe and effective treatment. During the short-term follow-up evaluation, EMR showed outcomes and complications comparable with prior procedures, including adenocarcinomas confined to the mucosa.
Topics: Adenocarcinoma; Adenoma; Adult; Aged; Aged, 80 and over; Decision Trees; Duodenal Neoplasms; Duodenoscopy; Female; Humans; Male; Middle Aged; Retrospective Studies
PubMed: 20490557
DOI: 10.1007/s00464-010-1114-y -
The Surgical Clinics of North America Jun 2001Our review supports the clinical impression that periampullary cancers vary in outcome after resection. Overall survival after pancreaticoduodenectomy is greatest for... (Review)
Review
Our review supports the clinical impression that periampullary cancers vary in outcome after resection. Overall survival after pancreaticoduodenectomy is greatest for patients with ampullary and duodenal cancers, intermediate for patients with bile duct cancer, and least for patients with pancreatic cancer. Moreover, survival for each tumor stage is greater for nonpancreatic periampullary cancers than for pancreatic cancers. Invasion of the pancreas by nonpancreatic periampullary cancers is a major factor adversely affecting survival. Recent data suggest that inherent differences in tumor biology rather than embryologic, anatomic, or histologic factors probably account for these differences in survival. Finally, although pancreaticoduodenectomy remains the procedure of choice for resectable periampullary cancers, further increases in survival will likely evolve through more effective neoadjuvant or adjuvant therapies rather than modifications in the surgical approach.
Topics: Ampulla of Vater; Bile Duct Neoplasms; Duodenal Neoplasms; Humans; Lymphatic Metastasis; Neoplasm Invasiveness; Pancreatic Neoplasms; Pancreaticoduodenectomy; Predictive Value of Tests; Prevalence; Survival Rate
PubMed: 11459270
DOI: 10.1016/s0039-6109(05)70142-0 -
Surgery Jul 2022National Comprehensive Cancer Network guidelines recommend resection and adjuvant chemotherapy for patients with locally advanced duodenal adenocarcinoma. Outcomes after...
BACKGROUND
National Comprehensive Cancer Network guidelines recommend resection and adjuvant chemotherapy for patients with locally advanced duodenal adenocarcinoma. Outcomes after systemic treatment in this rare malignancy have not been well studied. We examined utilization patterns of systemic treatment and compared overall survival of patients receiving neoadjuvant therapy, surgery alone, and adjuvant therapy.
METHODS
Patients with stage 0 to III duodenal adenocarcinoma undergoing curative-intent surgery were identified within the National Cancer Database from 2006 to 2015. Outcomes, including median overall survival and 30- and 90-day mortality, were compared based on treatment sequence (neoadjuvant, adjuvant, or surgery alone). Propensity score matching on likelihood of receiving systemic treatment and landmark analysis were performed to mitigate bias.
RESULTS
Of the 2,956 patients meeting inclusion criteria, most patients with known clinical stage had locally advanced disease (72%), of which 53% received systemic therapy (8% neoadjuvant, 45% adjuvant). After landmark analysis on the propensity matched cohort, patients with locally advanced disease who received systemic treatment had longer median overall survival compared to patients who underwent surgery alone (49 vs 40 months, P = .018) and a 20% lower hazard of mortality (hazard ratio 0.80, 95% confidence interval 0.69-0.93, P = .003). Patients who received neoadjuvant and adjuvant therapy had similar survival outcomes.
CONCLUSION
Adjuvant therapy was underutilized in patients with National Comprehensive Cancer Network guideline indications, despite an association with longer median overall survival and decreased hazard of mortality. Neoadjuvant therapy, although rarely used, had similar survival to adjuvant therapy. Given its other potential benefits, systemic treatment in the neoadjuvant setting may be a reasonable option in adequately selected patients with clinically advanced duodenal adenocarcinoma.
Topics: Adenocarcinoma; Chemotherapy, Adjuvant; Duodenal Neoplasms; Humans; Neoadjuvant Therapy; Neoplasm Staging; Retrospective Studies
PubMed: 35437164
DOI: 10.1016/j.surg.2022.03.009 -
Endoscopy Aug 2017Endoscopic resection is effective in treating nonampullary duodenal adenomas but has a high incidence of complications. Cold polypectomy, including cold forceps... (Clinical Trial)
Clinical Trial
Endoscopic resection is effective in treating nonampullary duodenal adenomas but has a high incidence of complications. Cold polypectomy, including cold forceps polypectomy (CFP) and cold snare polypectomy (CSP), is safe and effective in treating colorectal polyps. However, its utility in sporadic nonampullary duodenal adenomas has not been investigated. The purpose of this prospective study was to examine the safety and efficacy of cold polypectomy for sporadic nonampullary duodenal adenomas. Between March 2015 and June 2016, patients who were endoscopically diagnosed with sporadic nonampullary duodenal adenomas up to 6 mm underwent cold polypectomy. Patients with pathologically confirmed adenomas underwent endoscopic biopsy 3 months after resection. The main outcomes of interest were incomplete resection and complications. Overall, 39 lesions in 30 patients were removed via cold polypectomy (CFP, 9 lesions in 8 patients; CSP, 30 lesions in 22 patients). Seven of 9 (77.8 %) and 29 of 30 (96.7 %) lesions were removed en bloc via CFP and CSP, respectively. Pathologically, 34 of the 39 lesions (87.2 %) were confirmed as adenomas, and their mean size was 3.9 ± 1.2 mm (range 2 - 6 mm). Of the 34 adenomas, 20 (58.8 %) were R0 resection lesions, of which 3 of 9 (33.3 %) and 17 of 25 (68.0 %) had undergone CFP and CSP, respectively. No delayed bleeding or intraprocedural/delayed perforation was observed. All 30 patients with the 34 pathologically confirmed adenomas underwent upper gastrointestinal endoscopy 3 months after cold polypectomy, and no morphological or pathological recurrence was identified. In this small study, cold polypectomy appeared to be safe and effective in treating diminutive and small sporadic nonampullary duodenal adenomas.(Clinical trial registration number: UMIN000016829).
Topics: Adenoma; Aged; Aged, 80 and over; Duodenal Neoplasms; Duodenoscopy; Female; Humans; Male; Middle Aged; Neoplasm, Residual; Prospective Studies; Tumor Burden
PubMed: 28493238
DOI: 10.1055/s-0043-107028 -
Revue Des Maladies Respiratoires Apr 2023Gastrointestinal (GI) metastases in lung cancer rarely occur. (Review)
Review
INTRODUCTION
Gastrointestinal (GI) metastases in lung cancer rarely occur.
CASE REPORT
We report here the case of a 43-year-old male active smoker who was admitted to our hospital for cough, abdominal pain and melena. Initial investigations revealed poorly differentiated adenocarcinoma of the superior-right lobe of the lung: positive for thyroid transcription factor-1 and negative for protein p40 and for antigen CD56, with peritoneal, adrenal and cerebral metastasis, as well as anemia requiring major transfusion support. Over 50% of cells were positive for PDL-1, and ALK gene rearrangement was detected. GI endoscopy showed a large ulcerated nodular lesion of the genu superius with active intermittent bleeding, as well as an undifferentiated carcinoma with positivity for CK AE1/AE3 and TTF-1, and negativity for CD117, corresponding to metastatic invasion originating from lung carcinoma. Palliative immunotherapy with pembrolizumab was proposed, followed by targeted therapy with brigatinib. Gastrointestinal bleeding was controlled with a single 8Gy dose of haemostatic radiotherapy.
CONCLUSION
GI metastases are rare in lung cancer and present nonspecific symptoms and signs but no characteristic endoscopic features. GI bleeding is a common revelatory complication. Pathological and immunohistological findings are critical to diagnosis. Local treatment is usually guided by the occurrence of complications. In addition to surgery and systemic therapies, palliative radiotherapy may contribute to bleeding control. However, it must be used cautiously, given a present-day lack of evidence and the pronounced radiosensitivity of certain gastrointestinal tract segments.
Topics: Adenocarcinoma of Lung; Lung Neoplasms; Neoplasm Metastasis; Gastrointestinal Hemorrhage; Duodenal Neoplasms; Humans; Adult; Male; Cough; Abdominal Pain; Melena; Treatment Outcome
PubMed: 36868976
DOI: 10.1016/j.rmr.2023.02.003 -
Journal of Gastroenterology and... May 2021Although duodenal cancer is rare, no epidemiological research on this disease has been conducted in Asian countries. We aimed to elucidate the incidence and clinical...
BACKGROUND AND AIM
Although duodenal cancer is rare, no epidemiological research on this disease has been conducted in Asian countries. We aimed to elucidate the incidence and clinical features of duodenal cancer in Japan using a large-scale national database.
METHODS
Data of patients with primary duodenal cancer diagnosed from January 1, 2016, to December 31, 2016, were extracted from the Japanese national cancer registry. Excluding malignant neoplasm of the Vater's ampulla, we calculated the incidence among the population as a crude number of patients with duodenal cancer divided by the total Japanese population in 2016. We performed multivariate analyses using logistic regression models to identify risk factors for advanced cancer, defined as metastatic cancer or local invasion to adjacent organs.
RESULTS
Data on 3005 patients were included. The incidence of duodenal cancer was 23.7 per 1 000 000 person-years. In total, 56.4% of cases were detected at the localized stage. In the localized cancer group, endoscopic resection was more frequently performed (48.0%), whereas in the advanced cancer group, surgery and chemotherapy were the major treatment options (39.3% and 41.5%, respectively). Multivariate analyses identified age ≥80 years (odds ratio [OR], 1.489; 95% confidence interval [CI], 1.113-1.992; P = 0.007), incidental detection (OR, 2.325; CI, 1.623-3.331; P < 0.0001), and precise examination for symptomatic patients (OR, 10.561; CI, 7.416-15.042; P < 0.0001) as independent risk factors for advanced cancer.
CONCLUSIONS
Our study revealed the incidence of duodenal cancer in Japan. However, localized cancer was the major tumor stage at detection, resulting in a high rate of endoscopic resection.
Topics: Aged; Aged, 80 and over; Ampulla of Vater; Databases, Factual; Drug Therapy; Duodenal Neoplasms; Endoscopy, Gastrointestinal; Female; Humans; Incidence; Japan; Logistic Models; Male; Middle Aged; Neoplasm Staging; Registries; Risk Factors; Time Factors
PubMed: 33002211
DOI: 10.1111/jgh.15285 -
Surgery Today Jun 2022Tumor budding is a histological characteristic defined as the presence of small clusters of cancer cells at the invasion front. Its significance in duodenal...
PURPOSE
Tumor budding is a histological characteristic defined as the presence of small clusters of cancer cells at the invasion front. Its significance in duodenal adenocarcinoma (DA) has not been fully described.
METHODS
A single-center, retrospective study was conducted. Patients who underwent curative surgery for histologically diagnosed DA from January 2006 to December 2018 at Kansai Medical University Hospital were included. Tumor budding was counted per 0.785 mm and classified as low (0-4 buds), intermediate (5-9 buds), or high (≥ 10 buds).
RESULTS
In total, 47 patients were included. The 5-year overall survival and relapse-free survival rates were 77% and 72%, respectively. High tumor budding was seen in 15 patients (32%). Excluding patients with superficial type (pT1) DA (n = 22), high tumor budding [hazard ratio (HR) 13.4, p = 0.028], regional lymph node metastasis (HR 19.9, p = 0.039), and adjuvant chemotherapy (HR 0.056, p = 0.036) were independent factors related to the overall survival in multivariate analyses. Distant metastases occurred significantly more often in patients who had high tumor budding than in others (p = 0.039).
CONCLUSION
The data suggest that high tumor budding is a predictor of a poor prognosis in resected DA.
Topics: Adenocarcinoma; Duodenal Neoplasms; Humans; Lymphatic Metastasis; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; Prognosis; Retrospective Studies
PubMed: 34988677
DOI: 10.1007/s00595-021-02433-z -
Surgery Mar 2018To review our experience in patients undergoing operative treatment for duodenal polypoisis associated with familial adenomatous polyposis with an emphasis on operative...
BACKGROUND
To review our experience in patients undergoing operative treatment for duodenal polypoisis associated with familial adenomatous polyposis with an emphasis on operative approach and long-term outcomes.
METHODS
Duodenal polypoisis associated with familial adenomatous polyposis patients undergoing operative treatment were studied retrospectively excluding patients with preoperative duodenal cancer.
RESULTS
Of 767 patients in the database, 63 (8.2%) patients underwent operative treatment: 42 (67%) pancreas-sparing duodenectomy, 15 (24%) pancreatoduodenectomy, and 6 (9.5%) segmental duodenal resection; the majority for Spigelman stages III and IV polyposis. Overall 9.6% had adenocarcinoma postoperatively (28.6% in the pancreatoduodenectomy group; P = .01). The proportion of Spigelman stages III and IV with cancer were 9.5% and 6.5%, respectively. Pathologic upgrade to cancer in patients with low grade dysplasia and high-grade dysplasia on preoperative biopsy was 5.7% and 6.7%, respectively (P = .13). At a median follow-up of 16 years, 7.7% needed a second duodenal polypoisis associated with familial adenomatous polyposis-related operation. Progression to high grade dysplasia or cancer in the stomach occurred in 15.4% of patients. Median overall survival and recurrence-free survival was at least 16 years and 15.6 years. No significant group-based differences were noted on follow-up.
CONCLUSION
The majority of patients with duodenal polypoisis associated with familial adenomatous polyposis can achieve long-term, cancer-free survival with organ-preserving approaches (pancreas-sparing-duodenectomy and segmental-duodenal-resection) with survival not dependent on the type of resection.
Topics: Adenomatous Polyposis Coli; Adult; Disease-Free Survival; Duodenal Neoplasms; Female; Humans; Male; Middle Aged; Neoplasm Staging; Pancreaticoduodenectomy; Retrospective Studies; Survival Rate; Treatment Outcome
PubMed: 29331402
DOI: 10.1016/j.surg.2017.10.035 -
Diagnostic Cytopathology Oct 2019Small intestinal adenomas are uncommon. Majority of these occur in the region of the ampulla of Vater. Adenomas of the ampulla can be further subdivided into two...
Small intestinal adenomas are uncommon. Majority of these occur in the region of the ampulla of Vater. Adenomas of the ampulla can be further subdivided into two types-intestinal and pancreatobiliary. While intestinal adenomas are more frequent, pancreatobiliary adenomas are rare. There is limited literature regarding the role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in the diagnosis of ampullary/peri-ampullary neoplasms. Here, we describe the cytologic features of a pancreatobiliary neoplasm of the duodenum that was sampled by EUS-FNA. The aspirate was cellular and revealed cells with moderately abundant oncocytic cytoplasm. The nuclei were round with fine chromatin and focally prominent nucleoli. Although the concurrent biopsy showed no high-grade dysplasia or invasive carcinoma, the EUS and imaging findings were highly suspicious for invasion. A broad differential diagnosis is under consideration for a duodenal mass that encompasses neoplasms of the biliary tract, pancreas, duodenum, and ampulla of Vater. To our knowledge, cytologic features of a pancreatobiliary neoplasm of the duodenum have not been previously reported. Our case highlights the features seen on cytology with histologic correlation in the hopes of elucidating features to better characterize these lesions.
Topics: Adenoma; Aged, 80 and over; Bile Duct Neoplasms; Duodenal Neoplasms; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Humans; Male; Pancreatic Neoplasms
PubMed: 31276311
DOI: 10.1002/dc.24271