Surgical treatment and survival analysis of primary duodenal malignant tumor: a retrospective cohort study

Background: A primary duodenal malignant tumor (PDMT) is an extremely uncommon malignancy that originates from a gastrointestinal tract tumor. Currently, there is no unified, effective surgical treatment for PDMTs. In this retrospective study, we sought to analyze and evaluate the surgical procedure for PDMTs including pancreaticoduodenectomy (PD) and limited resection (LR), expect to inform the management of PDMT.

Methods: We retrospectively reviewed patients with PDMT who underwent PD and LR in General Surgery Department of Tianjin Medical University General Hospital from January 2014 to December 2019. The clinical characteristics of the malignant tumors among the different segment of the duodenum were analyzed. We analyzed and compared the efficacy and safety of these two surgical treatments. Through survival result of the patients, we analyzed the survival factors affecting the PDMT.

Results: Of the 94 patients, 60 (63.8%) were diagnosed with duodenal adenocarcinomas (DAs), 32 (34.1%) with duodenal gastrointestinal stromal tumors (d-GISTs), and 2 (2.1%) with duodenal lymphomas. Of the duodenal malignancies localized in the descending (D2) segment, 72.6% were DAs, and the initial symptom was jaundice (27.4%). Comparing with D2, d-GISTs were more common in the non-D2 segment (50.0%), and 46.9% of these patients presented with anemia as a primary symptom. PDs (87.1%) were more commonly performed for malignancies localized in the D2 segment, and LRs (59.4%) were more commonly performed for malignancies localized in the non-D2 segment (P<0.05).

Conclusions: In this study, we found that PDMT is more likely to occur in the D2 segment than the other segments, and the most common pathological type is DA. Treatment decisions for PD and LR might depend on the tumor type, location, and whether invasion of the pancreas. PD might be the first choice of treatment for PDMTs located in the D2 segment; otherwise, LR would be preferred. Further studies, preferably large randomized clinical trials, are needed to confirm these results.