Node-positive duodenal carcinoma is curable

J. Pickleman, M. Koelsch and G. Chejfec
Department of Surgery, Loyola University Medical Center, Maywood, III, USA.

OBJECTIVES: To document our experience with duodenal carcinoma during the past 15 years to ascertain optimal treatment. DESIGN: A retrospective case series. SETTING: A tertiary care referral center. PATIENTS: A consecutive sample of 24 patients, 17 men and 7 women, with duodenal carcinoma was evaluated during the 15 years ending in December 1992. Ages ranged from 44 to 81 years. All patients were available for follow-up for a minimum of 20 months. INTERVENTIONS: Therapy included 15 radical pancreaticoduodenectomies (Whipple procedures), 7 bypass operations, and 2 segmental resections. MAIN OUTCOME MEASURES: Tumor staging and survival. RESULTS: Segmental resections were performed in 2 patients, bypass operations in 7, and Whipple procedures in 15. One patient in each of the bypass and Whipple groups died postoperatively. All other patients who underwent bypass and segmental resection died of cancer. Of 14 patients surviving a Whipple procedure, 9 continue to survive with an average follow-up of 77 months. Four of these patients had lymph nodes involved with cancer and have survived for longer than 5 years. CONCLUSIONS: Adenocarcinoma of the duodenum gives rise to nonspecific gastrointestinal tract symptoms, and diagnosis is often delayed. Despite this delay, the Whipple procedure may still be curative for patients with positive lymph nodes, a fact poorly appreciated in the surgical literature. The role of segmental resection for distal duodenal tumors is unclear.