Localised cancer surgery
Complete removal (R0) of the primary tumour with loco-regional lymph node resection is recommended. In the context of posterior invasion, pre-operative treatment should be considered, and resection reconsidered after 2–3 months of chemotherapy.
In the context of unresectable metastases, primary tumour resection is not recommended except in an emergency such as bowel obstruction, perforation or uncontrolled bleeding. For duodenal tumours, a Whipple resection should be performed for a tumour in the second segment of the duodenum or for an infiltrating tumour in the proximal or distal duodenum. A duodenal resection alone could be performed for a proximal duodenal tumour or a distal duodenal tumour with no infiltration of adjacent organs. For jejunal and ileal tumours, an R0 resection with lymph node resection and jejuno-jejunal or ileo-ileal anastomosis should be performed. If the last ileal loop or Bauhin’s valve are involved, an ileocoecal or right hemicolectomy should be performed with ligation of the ileocolic artery so as to allow for lymph node resection