Villous Tumors of the Duodenum: Reappraisal of Local vs. Extended Resection

Michael B. Farnell, George H. Sakorafas, Michael G. Sarr, Charles M. Rowland, Gregory G. Tsiotos, David R. Farley, David M. Nagorney

Research output: Contribution to journalArticle

111 Citations (Scopus)

Abstract

Benign villous tumors of the duodenum are often managed by transduodenal local excision. Risk of local recurrence, coupled with improving safety of radical pancreaticoduodenectomy, has prompted reexamination of the roles of conservative and radical operations. The aim of this study was to determine long-term outcome after local and extended resection in order to identify factors to consider in planning operative strategy. Eighty-six patients (mean age 64 years) with villous tumors of the duodenum managed surgically from 1980 to 1997 were reviewed. Histologic findings, size, presence of polyposis syndromes, and extent of resection were correlated with outcome. Villous tumors were benign adenomas in 64 patients (74%), contained carcinoma in situ in three (4%), and invasive carcinoma in 19 (22%). The presence of cancer was not known preoperatively in 9 (47%) of the 19 with invasive carcinoma. Operative treatment included transduodenal local excision in 53 patients, pancreaticoduodenectomy in 20, pancreas-sparing duodenectomy in five, full-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 tumors after local excision is common and may be malignant. Pancreaticoduodenectomy is appropriate for villous tumors containing cancer and may be considered an alternative for select patients with benign villous tumors of the duodenum. If local excision is performed, regular postoperative endoscopic surveillance is mandatory.

Original languageEnglish (US)
Pages (from-to)13-21
Number of pages9
JournalJournal of Gastrointestinal Surgery
Volume4
Issue number1
StatePublished - Jan 2000

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Duodenum
Neoplasms
Pancreaticoduodenectomy
Recurrence
Carcinoma
Carcinoma in Situ
Adenoma
Pancreas
Adenocarcinoma
Safety

Keywords

  • Polyposis syndromes
  • Villoglandular polyps
  • Villous adenomas, periampullary neoplasms
  • Villous tumors

ASJC Scopus subject areas

  • Surgery

Cite this

Farnell, M. B., Sakorafas, G. H., Sarr, M. G., Rowland, C. M., Tsiotos, G. G., Farley, D. R., & Nagorney, D. M. (2000). Villous Tumors of the Duodenum: Reappraisal of Local vs. Extended Resection. Journal of Gastrointestinal Surgery, 4(1), 13-21.

Villous Tumors of the Duodenum : Reappraisal of Local vs. Extended Resection. / Farnell, Michael B.; Sakorafas, George H.; Sarr, Michael G.; Rowland, Charles M.; Tsiotos, Gregory G.; Farley, David R.; Nagorney, David M.

In: Journal of Gastrointestinal Surgery, Vol. 4, No. 1, 01.2000, p. 13-21.

Research output: Contribution to journalArticle

Farnell, MB, Sakorafas, GH, Sarr, MG, Rowland, CM, Tsiotos, GG, Farley, DR & Nagorney, DM 2000, 'Villous Tumors of the Duodenum: Reappraisal of Local vs. Extended Resection', Journal of Gastrointestinal Surgery, vol. 4, no. 1, pp. 13-21.
Farnell MB, Sakorafas GH, Sarr MG, Rowland CM, Tsiotos GG, Farley DR et al. Villous Tumors of the Duodenum: Reappraisal of Local vs. Extended Resection. Journal of Gastrointestinal Surgery. 2000 Jan;4(1):13-21.
Farnell, Michael B. ; Sakorafas, George H. ; Sarr, Michael G. ; Rowland, Charles M. ; Tsiotos, Gregory G. ; Farley, David R. ; Nagorney, David M. / Villous Tumors of the Duodenum : Reappraisal of Local vs. Extended Resection. In: Journal of Gastrointestinal Surgery. 2000 ; Vol. 4, No. 1. pp. 13-21.
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