Duodenal adenocarcinoma: Advances in diagnosis and surgical management

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.