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World J Gastrointest Surg. Mar 27, 2016; 8(3): 212-221
Published online Mar 27, 2016. doi: 10.4240/wjgs.v8.i3.212
Duodenal adenocarcinoma: Advances in diagnosis and surgical management
Jordan M Cloyd, Elizabeth George, Brendan C Visser
Jordan M Cloyd, Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
Elizabeth George, Brendan C Visser, Department of Surgery, Stanford University, Stanford, CA 94305, United States
Author contributions: Cloyd JM, George E and Visser BC contributed solely to this manuscript.
Conflict-of-interest statement: The authors report no relevant conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jordan M Cloyd, MD, Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, FCT 17.6055, Houston, TX 77030, United States. jmcloyd@mdanderson.org
Telephone: +1-713-7920029 Fax: +1-713-7453039
Received: August 26, 2015
Peer-review started: August 30, 2015
First decision: October 27, 2015
Revised: November 2, 2015
Accepted: December 13, 2015
Article in press: December 15, 2015
Published online: March 27, 2016
Abstract

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.

Keywords: Duodenal cancer, Duodenal adenocarcinoma, Periampullary, Whipple, Pancreaticoduodenectomy, Segmental resection, Small bowel

Core tip: Duodenal adenocarcinoma is a rare but aggressive malignancy. Complete surgical resection is recommended when technically feasible. Pancreaticoduodenectomy or segmental duodenal resection may be employed, depending on the tumor location, and either are acceptable options as long as negative margins and adequate lymphadenectomy can be achieved. Although specific data are limited, adjuvant chemotherapy and radiation should be considered for patients at high risk of recurrence.