TUMORS OF THE DUODENUM

Tumors of the duodenum are relatively rare, accounting for about 1-2% of all gastrointestinal neoplasms. Nevertheless diagnosis and therapy are important, as 50% of all duodenal neoplasms are malignant. In the period 1987-1992 we treated 14 patients with duodenal neoplasms(11 men , 3 women, age 30-81 years [median 60.4]). 5 patients had undergone pr evious treatment for malignant tumors (4 genito-urinary tract, 1 rectu m). The main symptoms were pain (43%), malaise (43%), weight loss (43% ), anemia (28%), jaundice (28%), obstruction (22%), nausea and/or vomi ting (22%). Diagnostic investigations were upper endoscopy (93%), comp uted tomography of the abdomen (72%), angiography or duplex-sonography (22%). Preoperative histology was malignant in 43%, benign in 22% and unclear in 35%. Surgery consisted of the following: duodenopancreatec tomy (Whipple procedure) in 4 (31%), segmental resection in 2 (15%), l ocal resection in 2 (15%), transduodenal excision of the ampulla of Va ter in 1 (7.5%), modified Finney pyloroplasty in 1 (7.5%), gastroenter ostomy in 2 (15%) and choledocho-jenunostomy in 1 (7.5%). One patient refused surgery or chemotherapy. The definitive histologies in the 13 operated cases were adeno-carcinoma in 8 (62%), leiomyosarcoma in 1 (8 %), leipmyoma in 2 (15%), and tubulo-villous adenoma in 2 (15%). The t umors were located in pars I in 3 (22%), in pars II in 9 (64%) and in pars III in 2 (14%). There were no postoperative complications in 9 pa tients (70%). 2 patients had an abscess of the abdominal wall or multi ple entero-cutaneous fistulas, and 2 patients died from multiple organ system failure. The 30-day mortality was 15.4% (2/13). These rare tum ors are difficult to diagnose because they are frequently asymptomatic until late in their course and rarely produce obstruction. Usually th e histology, obtained by upper endoscopy and malignant in 50%, is know n before surgery. The therapeutic options are segmental or local excis ion for benign lesions and duodenopancreatectomy (Whipple procedure) f or malignant lesions.