Abstract
Background
The aim of this study was to review the clinical features of primary duodenal adenocarcinoma (PDA) patients and to identify factors that influence survival. The natural history of PDA and the factors that affect patient outcome remain poorly defined.
Methods
The authors reviewed the medical records of 53 patients treated for PDA from January 1995 to May 2007.
Results
Altogether, 28 of the 53 patients (resectability 52.8%) underwent curative resection and 25 (47.2%) surgical palliation (bypass surgery or biopsy). Overall, the 3- and 5-year survival rates were 34.4% and 28.6%, respectively. Survival was significantly higher for patients who underwent curative resection (median survival 39 months; 3- and 5-year survivals 52.9% and 44.1%, respectively) than for those who underwent palliative surgery (median survival 8 months; 3-year survival 0%) (p < 0.001). T stage (p = 0.032) and nodal metastasis (p = 0.002) had significant negative effects on the survival of patients who underwent curative resection according to univariate analysis. However, multivariate analysis revealed that only nodal metastasis (p = 0.015) was significantly associated with survival.
Conclusions
The resectability of PDA was associated with increased survival, and metastasis to lymph nodes was found to be associated with reduced survival of patients with PDA. Findings indicate that an aggressive surgical approach should be pursued.
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References
Lillemoe K, Imbembo AL (1980) Malignant neoplasms of the duodenum. Surg Gynecol Obstet 150:822–826
Moss WM, McCart PM, Juler G et al (1974) Primary adenocarcinoma of the duodenum. Arch Surg 108:805–807
Pitt HA (2003) Duodenal cancer: endoscopic or surgical resection? J Clin Gastroenterol 37:356–357
Heniford BT, Iannitti DA, Evans P et al (1998) Primary nonampullary/periampullary adenocarcinoma of the duodenum. Am Surg 64:1165–1169
Ryder NM, Ko CY, Hines OJ et al (2000) Primary duodenal adenocarcinoma: a 40-year experience. Arch Surg 135:1070–1074, discussion 1074–1075
Gibbs JF (2004) Duodenal adenocarcinoma: is total lymph node sampling predictive of outcome? Ann Surg Oncol 11:354–355
Scott-Coombes DM, Williamson RC (1994) Surgical treatment of primary duodenal carcinoma: a personal series. Br J Surg 81:1472–1474
Rotman N, Pezet D, Fagniez PL et al (1994) Adenocarcinoma of the duodenum: factors influencing survival; French Association for Surgical Research. Br J Surg 81:83–85
Sexe RB, Wade TP, Virgo KS et al (1996) Incidence and treatment of periampullary duodenal cancer in the U.S. veteran patient population. Cancer 77:251–254
Alwmark A, Andersson A, Lasson A (1980) Primary carcinoma of the duodenum. Ann Surg 191:13–18
Jones BA, Langer B, Taylor BR et al (1985) Periampullary tumors: which ones should be resected? Am J Surg 149:46–52
Sohn TA, Lillemoe KD, Cameron JL et al (1998) Adenocarcinoma of the duodenum: factors influencing long-term survival. J Gastrointest Surg 2:79–87
Rose DM, Hochwald SN, Klimstra DS et al (1996) Primary duodenal adenocarcinoma: a ten-year experience with 79 patients. J Am Coll Surg 183:89–96
Bakaeen FG, Murr MM, Sarr MG et al (2000) What prognostic factors are important in duodenal adenocarcinoma? Arch Surg 135:635–641, discussion 641–642
Lai EC, Doty JE, Irving C et al (1988) Primary adenocarcinoma of the duodenum: analysis of survival. World J Surg 12:695–699
Delcore R, Thomas JH, Forster J et al (1993) Improving resectability and survival in patients with primary duodenal carcinoma. Am J Surg 166:626–630, discussion 630–631
Awrich AE, Irish CE, Vetto RM et al (1980) A twenty-five year experience with primary malignant tumors of the small intestine. Surg Gynecol Obstet 151:9–14
Joesting DR, Beart RW Jr, van Heerden JA et al (1981) Improving survival in adenocarcinoma of the duodenum. Am J Surg 141:228–231
Santoro E, Sacchi M, Scutari F et al (1997) Primary adenocarcinoma of the duodenum: treatment and survival in 89 patients. Hepatogastroenterology 44:1157–1163
Spira IA, Ghazi A, Wolff WI (1977) Primary adenocarcinoma of the duodenum. Cancer 39:1721–1726
Ouriel K, Adams JT (1984) Adenocarcinoma of the small intestine. Am J Surg 147:66–71
Michelassi F, Erroi F, Dawson PJ et al (1989) Experience with 647 consecutive tumors of the duodenum, ampulla, head of the pancreas, and distal common bile duct. Ann Surg 210:544–554, discussion 554–556
Schutz G, Aleksic M, Ulrich B (2000) Surgical treatment of non-ampullary duodenal cancer: good long term survival after radical tumour resection including lymphadenectomy. Int J Surg Invest 1:525–529
Pickleman J, Koelsch M, Chejfec G (1997) Node-positive duodenal carcinoma is curable. Arch Surg 132:241–244
Tocchi A, Mazzoni G, Puma F et al (2003) Adenocarcinoma of the third and fourth portions of the duodenum: results of surgical treatment. Arch Surg 138:80–85
Sarela AI, Brennan MF, Karpeh MS et al (2004) Adenocarcinoma of the duodenum: importance of accurate lymph node staging and similarity in outcome to gastric cancer. Ann Surg Oncol 11:380–386
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Lee, H.G., You, D.D., Paik, K.Y. et al. Prognostic Factors for Primary Duodenal Adenocarcinoma. World J Surg 32, 2246–2252 (2008). https://doi.org/10.1007/s00268-008-9678-6
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DOI: https://doi.org/10.1007/s00268-008-9678-6