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Abstract : |
BACKROUND: to analyse the distinctive clinicopathological and surgical features of an interesting case of voluminous malignant duodenal tumor. METHODS: the case of a male patient a voluminous tumor, of the third part of the duodenum involving the duodeno-jejunal angle is discussed. Adjacent viscera where involved, together with an important lympho-nodular tumor encasing superior mesenteric vessels. Paraaortic lymph nodes where also involved. While accomplishing the intended Harison-Debas operation, we آ´ve reached the â€â€point of no returnâ€‌ as follows. RESULTS: our planned Roux-en-Y duodeno-jejunostomy, as by-pass paliation of the â€â€unresectableâ€‌ malignant obstruction of the duodenum, turned into an inevitabely complex multivisceral resection thus increasing the operating time. CONCLUSIONS: sometimes, in case with apparently unresectable, tumors or, in cases where local or nodal extension makes resection useless, surgeons are compelled to performe extensive resections with no benefit on patient's survival expectancy; this frequently occures when preoperative assessment (i.e. angiography, MRI – angiography ) is incomplete. On the other hand, for well selected cases, resection might be the best paliation., |
