CARCINOMA OF THE PERIPAPILLARY PORTION OF THE DUODENUM

Duodenal adenocarcinoma: Advances in diagnosis and surgical management

Duodenal adenocarcinoma is a rare but aggressive malignancy. Given its rarity, previous studies have traditionally combined duodenal adenocarcinoma (DA) with either other periampullary cancers or small bowel adenocarcinomas, limiting the available data to guide treatment decisions. Nevertheless, management primarily involves complete surgical resection when technically feasible. Surgery may require pancreaticoduodenectomy or segmental duodenal resection; either are acceptable options as long as negative margins are achievable and an adequate lymphadenectomy can be performed. Adjuvant chemotherapy and radiation are important components of multi-modality treatment for patients at high risk of recurrence. Further research would benefit from multi-institutional trials that do not combine DA with other periampullary or small bowel malignancies. The purpose of this article is to perform a comprehensive review of DA with special focus on the surgical management and principles.

Carcinoma of the ampulla of vater. A clinicopathologic study and pathologic staging of 109 cases of carcinoma and 5 cases of adenoma

A total of 109 cases of carcinoma and 5 cases of adenoma of the ampulla of Vater were studied by preparing 5-mm step-wise whole tissue sections in each case. Carcinoma of the ampulla of Vater could be divided into four stages (I, II, III and IV), according to the microscopically verified extent of involvement by the tumor. All 12 patients with a Stage I tumor, defined as one restricted to within the muscle of Oddi as a boundary, showed no lymph node involvement and carried an excellent life expectancy with a relative 5-year survival rate of 85%. Thus, categorization of such a tumor as early carcinoma of the ampulla of Vater is valid. Excluding two unclassifiable cases, the remaining 95 patients with Stage II, III, or IV tumors extending beyond the boundary of Oddi carried relative 5-year survival rates of 11%, 25%, or 24%, respectively. Of the 109 carcinomas, 20 had areas of unequivocal adenoma at the margins, and of the five adenomas, two larger ones had foci of atypical epithelium suggestive of carcinoma in situ. These findings show the close relationship between adenoma and adenocarcinoma of the ampulla of Vater.

Carcinoma of the papilla of Vater. A review of fifty-seven cases

Fifty-seven cases of carcinoma of the papilla of Vater are reviewed. Clinical and pathologic features as well as results of various surgical treatments are summarized. The Whipple operation may be the operation of choice for cancer of the papilla of Vater, offering a chance for cure and obviating further surgery.