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Duodenal Adenocarcinoma: Has Survival Outcome Profile Changed in Recent Years?
Tolutope Oyasiji*, Julie a. Alosi, Chandler Wilfong, Neal Wilkinson
Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY
INTRODUCTION:
Duodenal adenocarcinoma is rare, therefore, little is known about its natural history or prognostic factors for survival. Major advancements in adjuvant chemotherapy for upper gastrointestinal cancers were recorded in the last decade. We aimed to evaluate surgical treatment and prognostic factors for survival in patients with duodenal adenocarcinoma in recent years.
METHODS:
We retrospectively reviewed all patients who were treated for duodenal adenocarcinoma at our institution between January 2000 and July 2013. Ampullary tumors were excluded.
RESULTS:
Of the 39 patients, 21 (53.8%) underwent surgery with curative intent and 6 (15.4%) underwent palliative operation. Of the curative surgery group, 13 underwent pancreaticoduodenectomy (PD) and 8 underwent segmental duodenectomy. R0 resection was achieved in 20(95.2%) of 21 patients who underwent curative resection. 4 patients received primary systemic chemotherapy for advanced disease. 7 patients declined any treatment due to advanced disease while 1 patient had palliative radiotherapy. The median survival of the entire cohort was 11 months (range 1-81). Median survival and survival rates for 1-, 3- and 5-year were better for the operative group (14 months, 60%, 35.4% and 12.1%) compared to non-operative group (7 months, 33.3%, 16.7% and 0%). Median survival and survival rates for 1-, 3- and 5-year were better for patients who underwent curative surgery (18 months, 92.9%, 62.5% and 16.7%) compared to palliative surgery group (5.5 months, 33.3%, 6.7% and 0%). Univariate analysis showed that female gender (P=0.04) and curative resection (P=0.03) were positive predictors of survival while nodal metastasis (P=0.0473) and advanced T- stage (P=0.047) were negative predictors. Only female gender and curative resection were significant predictors of OS on multivariate analysis.
CONCLUSION:
Our small series of duodenal adenocarcinoma has shown that overall survival still hinges significantly on achieving curative resection. This argues strongly for early detection when feasible and need to further investigate the role of adjuvant treatment modalities like chemotherapy.
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