Adenocarcinoma of the distal duodenum: two cases managed by pylorus preserving pancreatico-duodenectomy and adjuvant chemotherapy.

Adenocarcinoma of the distal duodenum: two cases managed by pylorus preserving pancreatico-duodenectomy and adjuvant chemotherapy Primary adenocarcinoma of the duodenum is a rare tumour which accounts for less than 0.5% of intestinal malignancies 1, 2, and the optimum treatment is unknown. Previous surgical treatment has consisted ofWhipple type pancreatico-duodenectomy or segmental resection , while chemotherapy has been confined to purely palliative cases3'6'7. In pancreatic diseases, pylorus preserving pancreatico-duodenectomy appears to offer advantages over the classical Whipple procedure 8, 9. However, there are few reported cases employing this operation in duodenal carcinoma'0, and there are no reports of the efficacy of chemotherapy to improve prognosis following potentially curative surgery. Case 1. A 64 year old male presented with symptoms and signs in keeping with gastric outlet obstruction. Barium meal revealed a stricture, suggestive of a tumour, in the third part of the duodenum (Figure). CT scan confirmed this and revealed no evidence of metastasis (Figure). Laparotomy confirmed a stenosing tumour of the third part of the duodenum. Intra-operative ultrasonography revealed no evidence of hepatic metastases. A pylorus preserving pancreatico-duodenectomy was performed and the patient made an uneventful postoperative recovery. Histological examination identified a primary duodenal adenocarcinoma with involvement of two local lymph nodes. Four courses of adjuvant chemotherapy, consisting of 5-fluorouracil, cisplatin, epirubicin and folinic acid were given, without significant complication. There was no evidence of ascites or recurrence on ultrasound scan at one year and he remains well 24 months following surgery.