Evidence of Surgical Management of Duodenal Cancer

Duodenal adenocarcinoma represents the most common histologic subtype of duodenal neoplasm, but remains rare overall. Risk factors for the development of duodenal adenocarcinoma include genetic predisposition, such as familial adenomatous polyposis (FAP) and other polyposis syndromes, as well as duodenal villous adenomas. Operative resection is the mainstay of curative therapy, and operative approaches include pancreatoduodenectomy and segmental duodenal resection depending on the location of the tumor within the duodenum. Prognostic factors after curative resection include lymph node metastases, positive lymph node ratio, and perineural invasion. The operative approach and tumor location within the duodenum have not impacted on prognosis. Data regarding the use of chemotherapy specifically in this neoplasm is limited, because these patients are often lumped together with other periampullary malignancies; however, no survival advantage has been demonstrated in limited adjuvant studies.