Abstract
We report a rare case of primary carcinoma originating from the first portion of the duodenum. A 63-year-old man, who complained of epigastric discomfort, was found to have an obstruction of the duodenum by upper gastrointestinal endoscopy and was referred to our hospital. Because no malignancy was ever confirmed, we chose conservative treatment. However, endoscopic examination showed no improvement. Thus, we decided to perform surgery. A specimen taken from nodules of the duodenal wall indicated malignancy, necessitating pancreaticoduodenectomy. We subsequently added adjuvant chemotherapy with oral S-1 administration, and he has survived without evidence of recurrence or metastasis for more than a year.
There is no doubt that the first line treatment for primary carcinoma of the duodenum should be curative surgery. However, the role of adjuvant chemotherapy is controversial and the guidelines for unresectable cases are unclear. The management of duodenal malignancy therefore needs to be further investigated in a multicenter trial.
