Four cases of primary duodenal adenocarcinoma in the fourth portion

Primary duodenal adenocarcinoma is rare, especially in the fourth portion of the duodenum. We report 4 patients with such findings, all of whom underwent curative resection. All patients had advanced cancer with circumferential stenosis, and 3 underwent pylorus-preserving pancreatoduodenectomy. Liver metastasis was found preoperatively in one patient, who underwent two-stage radical resection, i.e., duodenojejunal segmental resection with lymphadenectomy and right hepatectomy. Based on TNM staging, 1 patient had Stage IIA (T3N0M0), 2 had Stage IIIA (T3N1M0), and 1 had Stage IV disease (T3N0M1). Metastasis to superior mesenteric nodes was found in the 2 patients with Stage IIIA disease. The patient with Stage IIA remains alive 11 years after surgery. The 2 patients with positive lymph nodes survived for more than 5 years without evidence of recurrence. The patient with Stage IV disease died of lung metastasis at 12 months. In this report we discuss the appropriate operative method for duodenal adenocarcinoma of the fourth portion.