Clinical practice guidelines for duodenal cancer 2021

Abstract

Duodenal cancer is considered to be a small intestinal carcinoma in terms of clinicopathology. In Japan, there are no established treatment guidelines based on sufficient scientific evidence; therefore, in daily clinical practice, treatment is based on the experience of individual physicians. However, with advances in diagnostic modalities, it is anticipated that opportunities for its detection will increase in future. We developed guidelines for duodenal cancer because this disease is considered to have a high medical need from both healthcare providers and patients for appropriate management. These guidelines were developed for use in actual clinical practice for patients suspected of having non-ampullary duodenal epithelial malignancy and for patients diagnosed with non-ampullary duodenal epithelial malignancy. In this study, a practice algorithm was developed in accordance with the Minds Practice Guideline Development Manual 2017, and Clinical Questions were set for each area of epidemiology and diagnosis, endoscopic treatment, surgical treatment, and chemotherapy. A draft recommendation was developed through a literature search and systematic review, followed by a vote on the recommendations. We made decisions based on actual clinical practice such that the level of evidence would not be the sole determinant of the recommendation. This guideline is the most standard guideline as of the time of preparation. It is important to decide how to handle each case in consultation with patients and their family, the treating physician, and other medical personnel, considering the actual situation at the facility (and the characteristics of the patient).

Keywords: Clinical practice guidelines; Duodenal cancer; The Japan duodenal cancer guideline committee; Treatment.

Fig. 1

Diagnosis algorithm of duodenal cancer. CQ clinical question

Fig. 2

Treatment algorithm of resectable duodenal cancer. Although there is no evidence for additional surgery after local resection of the duodenum, a comprehensive decision an overall decision should be made whether to perform pancreato-duodenectomy plus lymph node dissection, taking into account pathological tumor and patient factors such as vascular invasion and residual cancer. Tis tumor confined to the lamina propria, SM tumor confined to the submucosa, CQ clinical question, EMR endoscopic mucosal resection, CSP cold snare polypectomy, ESD endoscopic submucosal dissection, LECS laparoscopy and endoscopy cooperative surgery, HM horizontal margin, VM vertical margin, EGD esophagogastroduodenoscopy

Fig. 3

Treatment algorithm of un-resectable duodenal cancer. CQ clinical question