1. DIAGNOSTIC AND THERAPEUTIC ASPECTS IN DUODENAL TUMORS
Şt. O. Georgescu, C.N. Neacşu, D. Vintilă, Paula Popa
University of Medicine and Pharmacy “Gr. T. Popa”
Research Center in Laparoscopic and Classic Surgery
Universitary Hospital “St. Spiridon”-1st Surgical Clinic
Iaşi, Romania

2. INTRODUCTION 1746 – Hamburger – the first case report
1876 – Leichtenstern – description of duodenal tumors
1894 – Pic – grouped duodenal tumors in: suprampullary, periampullary and inframpulary
1899 – W.S. Halsted – the first successful surgical resection of an adenocarcinoma of the ampulla of Vater

3. STUDY DESIGN Retrospective study 1996-2005
43 cases with duodenal tumors
BENIGN
n=4 (9%)
MALIGN
n=39 (91%)
Chi square and t tests; p<0.05

4. BENIGN TUMORS (n=4;9%) RESULTS Male=3; Female=1
Mean age=40.25±10.81 years (range 27 to 53 years)
Pathology
Location
Symptoms
Diagnosis
Surgery US
Endoscopy
Barium
enema CT
Immunohistochemistry
Schwanoma
Inframpullary
Obstruction + -
Enterectomy
Hamartoma (Peutz-Jeghers)
Infra- and suprampullary
Local excision
Suprampullary
Stromal tumor
Bleeding
No postoperative morbidity and mortality

5. PEUTZ-JEGHERS SYNDROME
STROMAL DUODENAL TUMOR (benign)

6. DUODENAL MALIGNANCIES (n=39; 91%)
RESULTS
DUODENAL MALIGNANCIES (n=39; 91%)
p=0.15
Mean age=65.89±11.12 years
(range 39 to 82 years)
p=0

7. DUODENAL MALIGNANCIES (n=39; 91%)
RESULTS
DUODENAL MALIGNANCIES (n=39; 91%)
p=0.047

8. DUODENAL MALIGNANCIES (n=39; 91%) Symptoms
RESULTS
DUODENAL MALIGNANCIES (n=39; 91%) Symptoms
Symptom n %
Weight loss 24
61.53
Jaundice 22
56.41
Nausea & vomiting 21
53.84
Pain 18
46.15
Astenia 16
41.02

9. DUODENAL MALIGNANCIES (n=39; 91%) Histology
RESULTS
DUODENAL MALIGNANCIES (n=39; 91%) Histology
The accuracy of diagnosis
The source for diagnosis
Histological type n %
SURE
The resection specimen or biopsy
Adenocarcinoma of ampulla of Vater* 14
35.9
Duodenal nonampullar adenocarcinoma** 7
17.9
Stromal malignant tumor (inframpullar) 1
2.6
PROBABLY
The surgical exploration
Unknown
43.6
Evidence of clinical and non-operative exploration data 3
*Two patients with endoscopic biopsy without surgery
**One patient with liver biopsy (metastasis)

10. DUODENAL MALIGNANCIES (n=39; 91%) Staging
RESULTS
DUODENAL MALIGNANCIES (n=39; 91%) Staging
p=0.002

11. DUODENAL MALIGNANCIES (n=39; 91%) Surgery
RESULTS
DUODENAL MALIGNANCIES (n=39; 91%) Surgery
33 patients underwent surgical procedures
Resecability by duodenopancreatectomy n=18; 54.54%

12. DUODENAL MALIGNANCIES (n=39; 91%) Duodenopancreatectomies (18 cases)
RESULTS
DUODENAL MALIGNANCIES (n=39; 91%) Duodenopancreatectomies (18 cases)
Traverso-Longmire (pilor-preserving) – 9 cases (50%)
Whipple – 7 cases (38.8%)
Whipple + colectomy (tumor) + enterectomy (tuberculosis) – 1 case (5.5%)
Child – 1 case (5.5%)

13. RESULTS
DUODENAL MALIGNANCIES (n=39; 91%) Morbidity &mortality related to duodenopancreatectomies
Pancreatic fistula – 2 cases
Duodeno-jejunal fistula (after pilor-preserving) – 1 case
Mortality – 2 cases (11.11%)
16.66%

14. CONCLUSIONS The duodenal tumors are rare
The most frequent location is in ampulla of Vater
Only duodenopancreatectomy can remove the entire malignancy (tumor and regional lymphnodes) but with the risk of a high morbidity and mortality
The resecability is related with the tumor’s stage, so the early diagnosis is mandatory