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Annals of Surgical Oncology

, Volume 19, Issue 6, pp 1928–1935 | Cite as

Duodenal Adenocarcinoma: Clinicopathologic Analysis and Implications for Treatment

  • George A. Poultsides
  • Lyen C. Huang
  • John L. Cameron
  • Richard Tuli
  • Leslie Lan
  • Ralph H. Hruban
  • Timothy M. Pawlik
  • Joseph M. Herman
  • Barish H. Edil
  • Nita Ahuja
  • Michael A. Choti
  • Christopher L. Wolfgang
  • Richard D. Schulick
Gastrointestinal Oncology

Abstract

Background

Duodenal adenocarcinoma is a rare cancer usually studied as a group with periampullary or small bowel adenocarcinoma; therefore, its natural history is poorly understood.

Methods

Patients with duodenal adenocarcinoma were identified from a single-institution pancreaticoduodenectomy database. Patients with adenocarcinoma arising from the ampulla of Vater were excluded. Univariate and multivariate analyses were performed to identify clinicopathologic variables associated with survival and recurrence after resection.

Results

From 1984 to 2006, a total of 122 patients with duodenal adenocarcinoma underwent pancreaticoduodenectomy. Overall survival after resection was 48% at 5 years and 41% at 10 years. Five-year survival decreased as the number of lymph nodes involved by metastasis increased from 0 to 1–3 to ≥4 (68%, 58%, 17%, respectively, P < 0.01) and as the lymph node ratio increased from 0 to >0–0.2 to >0.2–0.4 to >0.4 (68%, 57%, 14%, 14%, respectively, P < 0.01). Lymph node metastasis was the only independent predictor of decreased survival in multivariate analysis. Recurrence after resection was predominantly distant (81%). Adjuvant chemoradiation did not decrease local recurrence or prolong overall survival; however, patients who received chemoradiation more commonly had nodal metastasis (P = 0.03).

Conclusions

The prognostic significance of both the absolute number and ratio of involved lymph nodes emphasizes the need for adequate lymphadenectomy to accurately stage duodenal adenocarcinoma. The mostly distant pattern of recurrence underscores the need for the development of effective systemic therapies.

Keywords

Perineural Invasion Adjuvant Chemoradiotherapy Adjuvant Chemoradiation Synchronous Liver Metastasis Small Bowel Adenocarcinoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • George A. Poultsides
    • 1
    • 2
  • Lyen C. Huang
    • 2
  • John L. Cameron
    • 1
  • Richard Tuli
    • 3
  • Leslie Lan
    • 4
    • 5
    • 7
  • Ralph H. Hruban
    • 6
  • Timothy M. Pawlik
    • 1
  • Joseph M. Herman
    • 3
  • Barish H. Edil
    • 1
  • Nita Ahuja
    • 1
  • Michael A. Choti
    • 1
  • Christopher L. Wolfgang
    • 1
  • Richard D. Schulick
    • 1
  1. 1.Department of SurgeryJohns Hopkins Medical InstitutionsBaltimoreUSA
  2. 2.Department of SurgeryStanford University School of MedicineStanfordUSA
  3. 3.Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins Medical InstitutionsBaltimoreUSA
  4. 4.Departments of Epidemiology and BiostatisticsBloomberg School of Public HealthBaltimoreUSA
  5. 5.Division of Oncology Biostatistics, Sidney Kimmel Comprehensive Cancer CenterJohns Hopkins UniversityBaltimoreUSA
  6. 6.Department of PathologyJohns Hopkins Medical InstitutionsBaltimoreUSA
  7. 7.AlphaDetail Inc.San MateoUSA

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