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Gastrointestinal Endoscopy Aug 1997
Topics: Adult; Choristoma; Duodenal Diseases; Duodenal Neoplasms; Duodenum; Endocrine Gland Neoplasms; Humans; Male; Pancreas
PubMed: 9283871
DOI: 10.1016/s0016-5107(97)70069-5 -
Endoscopy Feb 2015Compared with any other location in the gastrointestinal tract, the duodenum presents the most challenging site for endoscopic resection. The aim of this study was to...
BACKGROUND AND STUDY AIMS
Compared with any other location in the gastrointestinal tract, the duodenum presents the most challenging site for endoscopic resection. The aim of this study was to analyze the clinical outcomes of duodenal endoscopic resection and to assess the feasibility of the technique as a therapeutic procedure.
PATIENTS AND METHODS
A total of 113 consecutive patients with 121 nonampullary duodenal tumors underwent endoscopic resection by endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), or polypectomy between January 2000 and September 2013. Long-term outcomes were investigated in patients with more than 1 year follow-up.
RESULTS
The median tumor size was 12 mm (range 3 - 50 mm). Lesions consisted of 63 adenocarcinomas/high-grade intraepithelial neoplasias (53 %) and 57 adenomas/low-grade intraepithelial neoplasias (48 %). Endoscopic resection included 106 EMRs (87 %), 8 ESDs (7 %), and 7 polypectomies (6 %). En bloc resection was achieved in 77 lesions (64 %), and 43 lesions (35 %) underwent piecemeal resection; one procedure was discontinued due to perforation. There were 14 cases of delayed bleeding after EMR (12 %), 1 perforation (1 %) during ESD, and 1 delayed perforation (1 %) after ESD, which required emergency surgery. Of the 76 patients who were followed for more than 1 year, none of the patients died from a primary duodenal neoplasm, and there were no local recurrences during the 51-month median follow-up period (range 12 - 163 months).
CONCLUSIONS
Duodenal endoscopic resection was feasible as a therapeutic procedure, but it should only be performed by highly skilled endoscopists because of its technical difficulty. Piecemeal resection by EMR is acceptable for small lesions, based on these excellent long-term outcomes.
Topics: Adenocarcinoma; Adenoma; Adenomatous Polyposis Coli; Aged; Carcinoma in Situ; Dissection; Duodenal Neoplasms; Endoscopy, Gastrointestinal; Feasibility Studies; Female; Follow-Up Studies; Humans; Intestinal Mucosa; Intestinal Perforation; Male; Middle Aged; Postoperative Hemorrhage; Retrospective Studies; Treatment Outcome; Tumor Burden
PubMed: 25314330
DOI: 10.1055/s-0034-1390774 -
Annals of Surgical Oncology Jun 2012Duodenal adenocarcinoma is a rare cancer usually studied as a group with periampullary or small bowel adenocarcinoma; therefore, its natural history is poorly understood.
BACKGROUND
Duodenal adenocarcinoma is a rare cancer usually studied as a group with periampullary or small bowel adenocarcinoma; therefore, its natural history is poorly understood.
METHODS
Patients with duodenal adenocarcinoma were identified from a single-institution pancreaticoduodenectomy database. Patients with adenocarcinoma arising from the ampulla of Vater were excluded. Univariate and multivariate analyses were performed to identify clinicopathologic variables associated with survival and recurrence after resection.
RESULTS
From 1984 to 2006, a total of 122 patients with duodenal adenocarcinoma underwent pancreaticoduodenectomy. Overall survival after resection was 48% at 5 years and 41% at 10 years. Five-year survival decreased as the number of lymph nodes involved by metastasis increased from 0 to 1-3 to ≥ 4 (68%, 58%, 17%, respectively, P < 0.01) and as the lymph node ratio increased from 0 to >0-0.2 to >0.2-0.4 to >0.4 (68%, 57%, 14%, 14%, respectively, P < 0.01). Lymph node metastasis was the only independent predictor of decreased survival in multivariate analysis. Recurrence after resection was predominantly distant (81%). Adjuvant chemoradiation did not decrease local recurrence or prolong overall survival; however, patients who received chemoradiation more commonly had nodal metastasis (P = 0.03).
CONCLUSIONS
The prognostic significance of both the absolute number and ratio of involved lymph nodes emphasizes the need for adequate lymphadenectomy to accurately stage duodenal adenocarcinoma. The mostly distant pattern of recurrence underscores the need for the development of effective systemic therapies.
Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Duodenal Neoplasms; Female; Follow-Up Studies; Humans; Lymph Nodes; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Pancreaticoduodenectomy; Prognosis; Retrospective Studies; Survival Rate
PubMed: 22167476
DOI: 10.1245/s10434-011-2168-3 -
Journal of Visceral Surgery Oct 2018
Topics: Carcinoma, Renal Cell; Duodenal Neoplasms; Humans; Kidney Neoplasms; Neoplasm Invasiveness; Photography
PubMed: 30017420
DOI: 10.1016/j.jviscsurg.2018.06.012 -
Digestive Endoscopy : Official Journal... Apr 2014We present our experiences with the so-called 'limited resections' such as transduodenal excision and local full-thickness resection for superficial non-ampullary... (Comparative Study)
Comparative Study
BACKGROUND AND AIM
We present our experiences with the so-called 'limited resections' such as transduodenal excision and local full-thickness resection for superficial non-ampullary duodenal tumors (SNADT). The optimal surgical management for SNADT is also discussed.
METHODS
Six patients with SNADT (adenoma, n=1; mucosal carcinomas, n=2; submucosal carcinoma, n=1; carcinoids, n=2) were included in this study. Four patients underwent transduodenal excision, one local full-thickness resection, and one laparoscopy-assisted endoscopic full-thickness resection as a modification of local full-thickness resection.
RESULTS
All patients were successfully treated by these limited resections without any adverse events.
CONCLUSIONS
Surgical resection is the treatment of choice for SNADT not amenable to endoscopic resection in terms of technical and/or oncological reasons. However, the optimal surgical management for SNADT remains controversial because of the complexity of the relevant anatomy of the duodenum, its rarity, the not well-known incidence of nodal metastasis, and the wide spectrum of pathologies that can be encountered.
Topics: Aged; Aged, 80 and over; Biopsy, Needle; Duodenal Neoplasms; Duodenoscopy; Female; Humans; Immunohistochemistry; Intestinal Mucosa; Laparoscopy; Laparotomy; Length of Stay; Male; Middle Aged; Minimally Invasive Surgical Procedures; Neoplasm Invasiveness; Neoplasm Staging; Operative Time; Prognosis; Retrospective Studies; Risk Assessment; Sampling Studies; Survival Rate; Treatment Outcome
PubMed: 24750150
DOI: 10.1111/den.12272 -
The Korean Journal of Internal Medicine Jan 2014Primary duodenal adenocarcinoma is a rare malignant neoplasm accounting for 0.3% of all gastrointestinal tract carcinomas. We herein present one case of duodenal...
Primary duodenal adenocarcinoma is a rare malignant neoplasm accounting for 0.3% of all gastrointestinal tract carcinomas. We herein present one case of duodenal adenocarcinoma after duodenal neuroendocrine carcinoma. Poorly differentiated duodenal neuroendocrine carcinoma with liver metastasis (TxNxM1) was confirmed, and eight cycles of palliative chemotherapy (5-fluorouracil/etoposide/cisplatin) were administered. The patient was then in a clinically complete response status. About 1 year later, newly developed adenocarcinoma was detected at the same site. It was completely surgically resected, and the patient was cured.
Topics: Adenocarcinoma; Antineoplastic Agents; Duodenal Neoplasms; Humans; Male; Middle Aged; Neoplasms, Second Primary; Neuroendocrine Tumors
PubMed: 24574838
DOI: 10.3904/kjim.2014.29.1.96 -
Surgery Today Apr 2011We report a case of adenocarcinoma of the minor duodenal papilla, a rare type of duodenal neoplasm. A 76-year-old man with a history of surgery for rectal cancer and...
We report a case of adenocarcinoma of the minor duodenal papilla, a rare type of duodenal neoplasm. A 76-year-old man with a history of surgery for rectal cancer and gastric cancer was referred to us after a follow-up upper gastrointestinal endoscopy revealed an abnormal elevation in the minor duodenal papilla. The pathological diagnosis of a biopsy specimen was adenocarcinoma. Preoperative examination of other organs revealed a tumor in the ascending colon, which was also identified as adenocarcinoma. We performed synchronous pancreatoduodenectomy and ileocecal resection with lymph node dissection. Histopathological examination of the resected specimen revealed that the papilla tumor arose from the duodenal mucosa and infiltrated the submucosa of the duodenal wall, but not the pancreatic parenchyma. Based on these findings, we diagnosed primary adenocarcinoma of the minor duodenal papilla. To our knowledge, this is only the sixth such case reported in the English-language literature, and we review all six cases after this case report.
Topics: Adenocarcinoma; Aged; Carcinoma, Pancreatic Ductal; Colonic Neoplasms; Duodenal Neoplasms; Endoscopy, Gastrointestinal; Humans; Lymph Node Excision; Male; Neoplasm Staging; Pancreatic Ducts; Pancreaticoduodenectomy
PubMed: 21431496
DOI: 10.1007/s00595-010-4314-0 -
Journal of Surgical Oncology Dec 2009Gastrointestinal stromal tumors (GISTs) occur rarely in the duodenum. The characteristics of duodenal GIST have not been well clarified. The aim of this study is to...
OBJECTIVE
Gastrointestinal stromal tumors (GISTs) occur rarely in the duodenum. The characteristics of duodenal GIST have not been well clarified. The aim of this study is to clarify the characteristics and surgical prognosis of patients with primary duodenal GIST.
METHODS
Data of patients with surgically treated primary duodenal GIST were retrospectively analyzed. Immunohistochemical expressions of p53, p16, and Ki-67 were evaluated to explain the prognosis.
RESULTS
Compared with gastric or small intestinal GISTs in historical studies, duodenal GISTs had a relatively smaller size, lower mitotic count, lower Ki-67 LI, lower p16 loss, and similar p53 expression. The 1- and 3-year recurrence-free survival rates of patients with complete resection were 100 and 95.2%.
CONCLUSION
Patients with completely resected primary duodenal GIST seem to have a more favorable prognosis. This may be related to the different expressions of some immunohistological makers compared with GISTs of other locations.
Topics: Adult; Aged; Aged, 80 and over; Cyclin-Dependent Kinase Inhibitor p16; Duodenal Neoplasms; Female; Follow-Up Studies; Gastrointestinal Stromal Tumors; Humans; Immunohistochemistry; Ki-67 Antigen; Male; Middle Aged; Neoplasm Proteins; Neoplasm Recurrence, Local; Prognosis; Retrospective Studies; Survival Rate; Tumor Suppressor Protein p53
PubMed: 19697360
DOI: 10.1002/jso.21378 -
Gastrointestinal Endoscopy Jul 2003
Topics: Biopsy, Needle; Disease Progression; Duodenal Neoplasms; Duodenoscopy; Fatal Outcome; Humans; Immunohistochemistry; Male; Melanoma, Amelanotic; Middle Aged; Neoplasm Staging; Risk Assessment; Skin Neoplasms
PubMed: 12838234
DOI: 10.1067/mge.2003.285 -
Acta Chirurgica Belgica Oct 2023Duodenal adenocarcinoma (DA) is a rare tumor for which survival data on adjuvant chemotherapy in patients after surgical treatment are unclear. This case-matched study...
BACKGROUND
Duodenal adenocarcinoma (DA) is a rare tumor for which survival data on adjuvant chemotherapy in patients after surgical treatment are unclear. This case-matched study in a nationwide cohort aims to investigate the benefit of adjuvant chemotherapy for patients with resectable DA on overall survival.
METHODS
All patients diagnosed with DA and intestinal type periampullary adenocarcinoma (PVA) in the Netherlands between 2000 and 2015 were included ( = 1316). Patients with disease stages II and III who underwent resection and adjuvant chemotherapy were matched (1:2), based on identified covariates associated with OS, with patients who underwent surgery alone. Overall survival was compared using Kaplan-Meier estimates.
RESULTS
The median OS was 49.9 months in patients who underwent curative resection ( = 649). Univariate and multivariate analysis showed a significant influence of age, lymph node involvement, and T- stage on survival. The group of patients receiving adjuvant treatment consisted of 43 patients and the non-adjuvant group of 83 case-matched patients. The median OS of the complete matched cohort ( = 126) was 26.9 months. No statistically significant survival benefit was found for the adjuvant group as compared to the group treated with surgery alone (median OS = 34.4 months and 23.0 months, = 0.20).
CONCLUSION
This population-based, case-matched analysis demonstrates no statistically significant survival benefit for adjuvant chemotherapy after curative resection in stages II and III patients. Future studies with specified treatment regimens as well as thorough stratification for prognostic factors will be required in order to more definitively determine the role of adjuvant therapy.
Topics: Humans; Chemotherapy, Adjuvant; Duodenal Neoplasms; Adenocarcinoma; Combined Modality Therapy; Lymph Nodes; Retrospective Studies; Neoplasm Staging
PubMed: 35727126
DOI: 10.1080/00015458.2022.2092961