Villous tumors of the duodenum: Reappraisal of local vs. extended resection

Benign villous tumors of the duodenum are often managed by transduodenal lo cal excision. Risk of local recurrence, coupled with improving safety of ra dical pancreaticoduodenectomy, has prompted reexamination of the roles of c onservative and radical operations. The aim of this study was to determine long term outcome after local and extended resection in order to identify f actors to consider in planning operative strategy. Eighty-six patients (mea n age 64 years) with villous tumors of the duodenum managed surgically from 1980 to 1997 were reviewed. Histologic findings, size, presence of polypos is syndromes, and extent of resection were correlated with outcome. Villous tumors were benign adenomas in 64 pa dents (74%), contained carcinoma in s itu in three (4%), and invasive carcinoma in 19 (22%). The presence of canc er was not known preoperatively in 9 (47%) of the 19 with invasive carcinom a. Operative treatment included transduodenal local excision in 53 patients , pancreaticoduodenectomy in 20, pancreas-sparing duodenectomy in five, ful l-thickness excision in four, and other in six. Among the 50 patients with benign tumors managed by local excision, 17 had a recurrence with actuarial rates of 32% at 5 years and 43 % at 10 years; four of the recurrences (24% ) were adenocarcinomas. The recurrence rate was influenced by the presence of a polyposis syndrome but not by tumor size. Recurrence of benign villous rumors after local excision is common and may be malignant. Pancreaticoduo denectomy is appropriate for villous tumors containing cancer and may be co nsidered an alternative for select patients with benign villous tumors of t he duodenum. If local excision is performed, regular postoperative endoscop ic surveillance is mandatory.