ĐÁNH GIÁ KẾT QUẢ ĐIỀU TRỊ PHẪU THUẬT UNG THƯ VÀ CÁC KHỐI U TÁ TRÀNG

Abstract

Retrospective study aimed at evaluation the clinical features and results of surgical management for tumor of duodenum and malignant duodenal tumors. Results: There were 10 patients, 6 male (60%), 4 female (40%), mean age 52,5 year old, Symtomps:abdominal pain (90%), gastrointestinal bleeding 30%. gastric outlet obstruction 30%. CTScan detechted 90% duodenal tumor; Gastroduodenalscopy showed 60% duodenal lesions; endoscopic ultrasound detechted 20% duodenal GIST. Emmergency operation in 20% (blood loss shock). Intraoperation findings: Duodenal adenocarcinoma (DII) in 1 patient; Duodenal GIST in 6 patients: of them 2 tumor located at DII duodenum below ampulla of Vater, 2 tumors located at junction DII-DIII of duodenum, 1 tumor located at duodenal DIII-DIV. Operation performed: Panceatic-duodenectomy (PD) in 1 patient; duodenal DII segmentectomy (AC proximal to ampulla) and subtotal gastrectomy with duodenostomy for compression in 1 patents; Duodenal DII segmentectomy, antrectomy with duodenostomy for compression in 1 patients (GIST located below ampulla); Duodenal DII-DIII segmentectomy, end to end annastomosis, antrectomy with duodenostomy for compression in 3 patients (GIST at DII-DIII junction); Duodenal DII-DIII-DIV segmentectomy, end to end annastomosis, antrectomy with duodenostomy for compression in 1 patients (GIST DIII-DIV); Suture for hemostasis, antrectomy with duodenostomy in 1 patient (blood loss shocks); Gastrojejunostomy and hepato-jejunostomy in 1 patient. + There were no death per- post operation and  30 days post operation. + Complication: 3 fistulas (1 patient post PD; other 2 patents post segmental resection) that healing spontaneously by medical treatment. Conclusion: We concluded that: Duodenal AC and other duodenal tumor are rare (the proportion < 1% for AC, < 4-5% for GIST). The symptoms were abdominal pain, gastrointertinal bleeding, gastric outlet obstruction. - For AC of duodenum: Pancreatic-duodenectomy (PD) or segmental resection obtained the same overall survival. Lymphatic metastasis is important pronostic factor. - For GIST of duodenum: PD, segmental resection or wedge resection could be performed. PD was indicated in case of ampulla involvement with elevated mortality and morbility. Duodenal segmentectomy had low mortality and morbility and  equal overall survival (OS) in case  R0 margin be obtained (1-2 cm from GIST tumor).