Surgical Treatment And Survival Analysis Of Primary Duodenal Malignant Tumor

Objective: In this retrospective study,we analyzed the clinicopathological data of primary duodenal malignant tumors,also compared clinical effects of pancreatoduodenectomy and limited resection.and the reasonable choice of surgical treatment for primary duodenal malignant tumor were explored.Method:We retrospectively reviewed the clinical medical records of patients with primary duodenal malignant tumor in General Surgery Department of Tianjin Medical University General Hospital from January 2014 to December 2019.We analyzed and compared the clinicopathological characteristics of malignant tumors in the nipple and non-nipple areas,surgical treatment effects of the two groups of patients,and then comparison of the long-term efficacy of pancreatoduodenectomy and localized duodenal resection by survival analysis.Result:(1)In the 94 patients,there were 60 cases of duodenal adenocarcinoma(63.8%),32 cases of duodenal gastrointestinal stromal tumor(34.1%),and 2 cases of duodenal malignant lymphoma(2.1%);The most common tumor was duodenal adenocarcinoma,and it was common in the duodenal papilla area,namely the descending part of duodenum(66.0%).Most patients had abdominal pain(26.6%)as the most common clinical symptom.(2)Duodenal malignant tumors in the nipple area were more common duodenal adenocarcinoma(72.6%),and the first clinical symptom were more common jaundice(27.4%);duodenal malignant tumors in the non-nipple area were more common the duodenal gastrointestinal stromal tumors(50.0%),the first clinical symptoms of patients were common anemia(46.9%).PD was more used in tumors of the nipple area,and LR was more suitable for tumors in the non-nipple area(P = 0.000).(3)Duodenal adenocarcinoma(79.1%)was the most common pathological type of tumor in the PD group,and the clinical symptoms of the patients were mostly abdominal pain(28.4%);Duodenal gastrointestinal stromal tumors(70.4%)were more common in the LR group,and symptoms were mostly anemia(51.9%).The results of liver function levels of patients in the PD group,such as alanine aminotransferase,aspartate aminotransferase,total bilirubin and direct bilirubin were higher than those in the LR group(P<0.05).Therefore,PD patients had more jaundice than the LR group(P = 0.002).The median postoperative hospital stay in the PD group was longer than that in the LR group(P = 0.015).(4)There were 45 cases of duodenal adenocarcinoma in the nipple area,15 cases of duodenal adenocarcinoma in the non-nipple area;all patients with adenocarcinoma in the nipple area underwent PD,but 8(53.3%)of patients with adenocarcinoma of the non-nipple area underwent PD and 7 patients(46.7%)underwent LR.There was a significant statistical difference between the two group(P <0.001).The proportion of PD in duodenal GIST patients in the nipple area was more than that in the non-nipple area,but there was no significant statistical difference between the two(P = 0.473).The selection of GIST in the non-nipple area was statistically correlated with the tumor diameter(P = 0.039).(5)The operation time of PD group was longer than that of LR group(P =0.000),and the intraoperative blood loss of PD group was higher than that of LR group(P=0.003).The incidence of postoperative complications of PD was not statistically different from that of the LR group(P = 0.553),however,the incidence of postoperative pancreatic fistula in the PD group was higher than that in the LR group(P = 0.005).And the incidence of delayed gastric emptying in the LR group was slightly higher than that in the PD group(P = 0.002).(6)Different surgical methods have no statistical difference in survival of patients with duodenal adenocarcinoma and duodenal gastrointestinal stromal tumors(OS,P = 0.732,P = 0.614;PFS,P = 0.777,P = 0.413).Therefore,in the case of ensuring radical treatment,the long-term efficacy of LR is equivalent to PD.Conclusion: PDMT occurs in the nipple area,and the pathological type is more common in duodenal adenocarcinoma;The choice of two surgical methods depends on factors such as tumor type,tumor location,and pancreatic invasion.When PDMT is located in the duodenal papilla area or invades the pancreas,PD is the preferred surgical method;when the tumor is located in the non-nipple area or does not invade the pancreas,LR is the first choice for surgical treatment.LR can shorten the hospitalization time and operation time,and has the same long-term clinical efficacy as PD.