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1999 Abstract: 3469 VILLOUS TUMORS OF THE DUODENUM: REAPPRAISAL OF LOCAL VERSUS EXTENDED RESECTION

Abstracts
1999 Digestive Disease Week

# 3469 VILLOUS TUMORS OF THE DUODENUM: REAPPRAISAL OF LOCAL VERSUS EXTENDED RESECTION
G H Sakorafas, M G Sarr, G G Tsiotos, D R Farley, D M Nagorney, Michael B Farnell, Mayo Clin, Rochester, MN

Background: Benign villous tumors of the duodenum are often managed by transduodenal local excision (LE). Risk of local recurrence, coupled with improving safety of radical pancreaticoduodenectomy (PD), have prompted re-examination of the roles of conservative and radical operation. Aim: To determine long-term outcome after local and extended resection in order to identify factors to consider in planning operative strategy. Methods: Eighty-six patients (mean age 64, range 31-85 yr) with histologically-confirmed villous tumors of the duodenum were managed surgically from 1980-1997. Sixteen patients (19%) had a polyposis syndrome. Effect of histology, size, presence of polyposis syndrome and extent of resection were correlated with outcome. Results: Villous tumors were solitary in 76 patients and multiple in 10; 70% of solitary tumors were periampullary. Mean size was 31 mm (5-90 mm). Tumors were benign adenomas in 64 patients (75%), contained cancer-in-situ in 3 (4%), and invasive carcinoma in 19 (22%). Presence of cancer was not known preoperatively in 3 patients with cancer-in-situ and in 9 of 19 (47%) with invasive carcinoma in the villous tumor. Operative treatment included transduodenal LE in 53 patients, PD in 20, pancreas-sparing duodenectomy in 5, full thickness excision in 4, segmental resection in 2, and palliative procedures in 2. One death occurred after PD. Significant morbidity occurred in 23 patients (27%). Follow-up (x ± SEM) was 5.6 ± 3.8 years (0.3-16 yr) and was complete in 95%. In the 50 patients with benign villous tumors managed by transduodenal LE, there have been 17 recurrences with actuarial rates of 30% at 5 years and 41% at 10 years; 4 of the 17 (24%) recurrences were adenocarcinoma. In the 19 patients with invasive carcinoma, 5-yr actuarial survival was 50%. Recurrence rate was not influenced by tumor size or presence of polyposis syndrome. Conclusion: Recurrence of villous tumors of the duodenum after LE is progressive, common and may be in malignant form. Malignancy in the villous tumor will not be known preoperatively in a significant proportion of patients. PD prevents recurrence, is appropriate for villous tumor containing cancer and may be considered as an alternative for select, fit patients with benign villous tumor of the duodenum. If LE is performed, regular postoperative endoscopic surveillance is mandatory.

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