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Background: Duodenal adenocarcinoma constitutes 44-55% of small bowel malignancies. Despite resection, the disease-free survival (DFS) and overall survival (OS) remains poor and is estimated to range from 15-53% in node- positive and 38-83% in node-negative at 5 years. Our aim was to describe the surgical management of patients with duodenal adenocarcinomas. Methods: We reviewed, retrospectively, the medical records of 124 patients treated for duodenal carcinoma by surgical palliation or curative resection from January 1994 to January 2009 at our institution. Results: 124 consecutive patients (75 males/ 49 females) underwent surgical treatment for duodenal adenocarcinoma between 1/1994 and 1/2009. The mean age at diagnosis was 65 years (range 33-87 years). 110 patients (89%) were diagnosed by endoscopic biopsy and 14 patients by CT or surgical exploration. There were 25 periampullary tumors and 99 extrampullary tumors. Eight patients had adenocarcinoma in the first portion of the duodenum (D1), 73 in the second portion (D2), 23 in the third portion (D3), and 15 in the fourth portion (D4). Two patients had tumors at the junction of D1 and D2, one patient had tumors at the junction of D2 and D3 and two at the junction of D3 and D4. The average tumor size was 4.1 cm (range 0.2-10 cm). Seventy nine (64%) patients had grade 3 tumors, 27 patients (22%) had grade 2 and fifteen patients (12%) had grade 4 tumors. There were no grade 1 tumors. Three patients had metastatic disease that was confirmed at operation. Nine patients had stage 1, 26 patients had stage 2, 33 had stage 3, and 56 had stage 4 disease. Eighty percent of patients underwent curative resection. Thirty four (34%) patients had pyloric preserving Whipple resection, 33 (33%) patients underwent a standard Whipple resection, 28 (28%) patients had segmental resection, 25 (20%) had palliative bypass surgery and 3 (3%) patients underwent Whipple with en bloc resection. Six patients had positive margins, 93 had negative margins. Fifty-one patients had node-positive disease and 49 had node-negative disease. The 5-year OS and DFS rates were 37 % and 56%, respectively, for patients with extra-ampullary adenocarcinomas, and 38% and 55%, respectively, for patients with periampullary tumors. Advanced T stage and pathologic grade 3 or 4 were associated with decreased survival. Nodal status and margin status had no significant impact on overall survival. There was no difference in survival between periampullary and extra-ampullary duodenal tumors. Conclusion: Duodenal adenocarcinoma is a rare and found in the second portion of the duodenum in 59% of patients. Advanced T stage and pathologic grade is associated with poor survival. Extra-ampullary and periampullary carcinomas have similar survival following resection. Aggressive surgical resection remains the mainstay of treatment.