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Primary Duodenal Adenocarcinoma : A 14-Years Experience With 16 Resected Cases
Akira Nakashima*, Hiroki Kitagawa, Yuta Ibuki
Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
Backgrounds: Primary duodenal adenocarcinomas (PDAs) exclusive of ampullary carcinoma comprise <0.3% of gastrointestinal malignancies. The rarity of PDAs leads to unassured therapeutic strategy.
Methods: Data were collected, retrospectively, by reviewing the medical records of 16 consecutive patients who underwent tumor resection for PDAs in our institution from April 2001 to October 2014. Long-term outcomes and predictors of survival with tumor resection were analyzed.
Results: Median age was 73 (48-86) years with 12 (75%) being male. 8 (50%) patients had first symptom; epigastraligia (5 patients), emesis (4 patients), jaundice (1 patients). The tumor was located on the 2nd portion of duodenum in 8 (50%) patients, and 1st or 3rd portion in 4 (25%) patients, respectively, and the median diameter was 39mm (5-90) with serum tumor maker elevation in 5 (31%) cases. 11 (69%) patients underwent surgical resection (9; pancreaticoduodenectomy, 2; partial resection), while 5 (31%) patients underwent endoscopic resection. The median duration of follow-up was 34 months. Overall survival rate was 58% at 5 years. Tumor location (3rd portion, p=0.035), existence of symptom (p=0.039), tumor size (40mm over, p=0.014), UICC T3/T4 (p=0.028), and R2 resection (p=0.005) were factors associated with a poor prognosis by univariate analyses. Four of 6 patients diagnosed pathologically T3 or T4 with lymph node metastases underwent R0/1 resection and have long-term survival with median 30(18-60) months.
Conclusions: Although our study is small number of patients, patients with poor prognostic factors of PDA may obtain prolonged survival by R0 resection with lymph node dissection.
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