PRIMARY NONAMPULLARY DUODENAL ADENOCARCINOMA

L'adenocarcinoma del duodeno e' una rara patologia che rappresenta circa lo 0.3-0.5 % di tutte le neoplasie maligne del tratto gastroenterico. Malgrado il duodeno rappresenta meno del 10 % della totale lunghezza dell'intestino tenue, circa il 45% delle neoplasie dell'intestino tenue si presentano nel duodeno. Essendo i sintomi dei questa malattia non specifici la diagnosi di carcinoma del duodeno e' molto difficile e molto spesso tardiva. Tuttavia il carcinoma del duodeno ha una sopravvivenza a 5 anni per tumori resecati tra il 25 e il 75%. Nell'ultimo decennio differenti studi hanno identificato diversi fattori prognostici associati alla sopravvivenza. Questi studi hanno mostrato che il grado istologico, le dimensioni del tumore,il coinvolgimento transmurale e dei linfonodi possono influenzare la sopravvivenza. L'obbiettivo di questa tesi e' di migliorare la conoscenza di specifici fattori prognostici associati alla sopravvivenza in pazienti affetti da adenocarinoma primario del duodeno. Tramite uno studio retrospettivo , 37 pazienti con diagnosi di adenocarcinoma del duodeno tra il 1989 e il 2009 sono stati identificati tramite il database del dipartimento di Chirurgia B dell'Universita' di Verona. Dall'analisi dei dati e' risultato che le complicanze operatorie possono influenzare in maniera significativa la sopravivenza in pazienti affetti da adenocarcinoma del duodeno.

Primary Adenocarcinoma of the duodenum is a rare condition, accounting between 0, 3% and 0, 5% of all gastrointestinal malignancies . Despite the duodenum is representing less than 10 % of the total length of the small bowel, this organ is the site of between 25% and 45% of the small bowel cancers 4. However cancer of the duodenum appeared to be more frequent in the proximity of the Ampulla of Vater periampullary area , about 45 % of them demonstrated to arise in third and in fourth por-tions of this organ. Since the symptoms of this cancer are non-specific and similar to other benign conditions, the diagnosis is often difficult and delayed. Nonetheless, duodenal carcinoma has a reported 5-year survival rate for resected tumours between 25% and 75% which is significantly better than that for cancer of the ampulla (46%) and the head of pancreas (10%) . In the last decade different studies evaluated the correlations between clinical, pathological and treatment variables in order to identified specific prognostic factors associated with survival . Those recent studies showed that histological grade, transmural involvement, tumour size, lymph node involvement and distant metastasis can influence the survival in patients with duodenal adenocarcinoma. However, due to a low incidence of this disease in the general population, the debate on prognostic factors in duodenal adenocarcinoma is still open. Therefore, questions have been raised especially on the prognostic significance of the absolute number and ratio of involved lymph nodes. A recent study has led an increased interest on perineural invasion as single independent prognostic factor for patients with primary duodenal cancer . Aims of research The aim of this thesis was to improve understanding of specific prognostic factors associated to survival in primary duodenal adenocarcinoma. A retrospective review of 37 patients diagnosed with primary duodenal adenocarcinoma between 1989 and 2009 was performed at Hepato-pancreatico-biliary department, General Surgery B, Verona University, Borgo Roma Hospital. Data were acquired then analysed for impact on recurrence and 5-year overall survival rate. From this retrospective study, , the development of postoperative complications is an additional prognostic factor after potentially curative resection for primary duodenal adenocarcinoma. This emphasized the need for centralization to high-volume centres, where an appropriate postoperative care can be delivered.