Duodenal Leiomyosarcoma

Abstract

Malignant stromal tumours of the duodenum are rare. The efficacy of surgical resection for duodenal leiomyosarcoma was assessed in 5 patients treated over an 11-year period, probably the largest series treated by a single surgeon. There were 3 women and 2 men with an age range of 27–52 years. Tumours were large (8.5–21 cm diameter) and partly cystic (4 cases). They arose from the second (2), third (2) and fourth parts of the duodenum. Resection was a major undertaking and comprised either partial duodenectomy (n = 4) or Whipple resection. Two patients required a right hemicolectomy in addition. Two patients with positive resection margins had adjuvant radiotherapy. Operative time ranged from 4.0 to 6.25 h and blood loss from 1.8 to 4.5 litres. Two patients developed complications: a transient low-output biliary fistula and an infected haematoma requiring percutaneous drainage. The 2 patients with incomplete resection died of recurrent disease at 3 and 15 months. The 3 survivors are free of disease at 24, 60 and 66 months. The results support a policy of aggressive resection despite the technical difficulties posed by these large and vascular tumours.

Pancreas-Sparing Distal Duodenectomy for Infrapapillary Neoplasms

“…35 It is generally agreed that the treatment of choice is surgical removal of the mass. 1,[36][37][38] Local resection is appropriate when feasible, but wide resection can be justified as invasion of adjacent organs does not preclude a cure. Duodenal GISTs have a mean survival of 50 months 35 and a 5-year survival of almost 50%.…”

Léiomyosarcome duodénal: description d'un cas révélé par une hémorragie digestive

“…Pourtant, 50 % des carcinomes du grêle siègent dans le duodénum ; les lymphomes et les sarcomes sont par contre rares dans le duodé-num, et la plupart sont répartis sur le jéjunum et l'iléon [4]. Seulement 15 à 28 % des léiomyosarcome de l'intestin grêle se situent sur le duodénum et représentent 10 % des tumeurs duodénales malignes [5]. Le léiomyosarcome duodénal atteint plus fréquemment les hommes que les femmes [4].…”

Leiomyosarcoma of the Duodeno-Jejunal Angle: Two Case Reports and Literature Review

“…Indeed, on one hand the anatomical complexity of the duodenum imposes different procedures adapted to the location of the tumor, and on the other hand, the rarity of lymph node metastases arouses debate for the need for node dissection. Among the published cases, only 52 cases had a curative surgery [2][3][4][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. The review of the various procedures carried out (Table 1) found that the choice of surgical procedure depended much more on the location and the size of the tumor that on the need for node dissection.…”

“…To achieve this, the resection should remove when possible all the adjacent invaded organs [6,8]. As for our second patient, the survival becomes compromised if the resection margins are invaded [9].…”