[Clinical characteristics and diagnosis and treatment of malignant tumor of the duodenum].

OBJECTIVE: To analyze the clinical characteristics of the malignant tumor of the duodenum and to improve the diagnosis and treatment.

METHODS: The clinical data of 100 cases with malignant tumor of the duodenum at Peking University Third Hospital from 1974 to 2010 were summarized retrospectively. According to the different location of the tumors,the cases were divided into two groups: papilla tumor group and non-papillary region tumor group.Then the clinical manifestations, treatment and prognosis in the two groups were separately statistically compared.

RESULTS: Most of duodenal tumors were located in the descendent part, especially in the duodenal papilla. Common clinical manifestations included upper abdominal pain, jaundice, black stool, intestinal obstruction and abdominal mass. Jaudice often occurred in papilla tumors (42/59), and black stool was usually detected in the tumors outside papilla (12/41). Intestinal obstruction and palpable abdominal mass often indicated advanced stage. Duodenofiberscope, combined with air barium double contrast radiography, could increase the diagnosis rate(90%). For papilla tumors, endoscopic retrograde cholangio-pancreatography (ERCP) was the best diagnostic method (100%). In the study, 56 cases underwent standard pancreaticoduodenectomy, 9 cases underwent simple tumor resection and 12 cases received segmental duodenectomy, and other 15 cases underwent palliative short-cut procedures. The resection rate was 84.2%(80/95) and radical resection rate was 62.1%(59/95). Either resection rate [91.4%(53/58) vs.72.9%(27/37), χ(2)=5.756,P=0.016] or radical resection rate [87.9% (51/58) vs.21.6%(8/37), χ(2)=42.204,P<0.0001] in the group of papilla tumors was significantly higher than in the group of non-papillary region tumors. Accordingly, the postoperative five year survival rate of the papillary carcinoma group was 44.8% (26/58) while that of the non-papillary region tumor group only 29.7% (11/37).

CONCLUSION: It will help the clinician to early diagnose the maligment tumors of the duodenum if the rational examinations were performed timely for the doubtable cases, especially for non-papillary region tumor. Pancreaticoduodenectomy is still the best way to treat this disease.