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01-06-2012 | Gastrointestinal Oncology

Duodenal Adenocarcinoma: Clinicopathologic Analysis and Implications for Treatment

Authors: George A. Poultsides, MD, Lyen C. Huang, MD, MPH, John L. Cameron, MD, Richard Tuli, MD, PhD, Leslie Lan, MPH, MBA, Ralph H. Hruban, MD, Timothy M. Pawlik, MPH, MBA, Joseph M. Herman, MD, MSc, Barish H. Edil, MD, Nita Ahuja, MD, Michael A. Choti, MD, MBA, Christopher L. Wolfgang, MD, PhD, Richard D. Schulick, MD, MBA

Published in: Annals of Surgical Oncology | Issue 6/2012

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.

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Title: Duodenal Adenocarcinoma: Clinicopathologic Analysis and Implications for Treatment
Authors: George A. Poultsides, MD
Lyen C. Huang, MD, MPH
John L. Cameron, MD
Richard Tuli, MD, PhD
Leslie Lan, MPH, MBA
Ralph H. Hruban, MD
Timothy M. Pawlik, MPH, MBA
Joseph M. Herman, MD, MSc
Barish H. Edil, MD
Nita Ahuja, MD
Michael A. Choti, MD, MBA
Christopher L. Wolfgang, MD, PhD
Richard D. Schulick, MD, MBA
Publication date: 01-06-2012
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 6/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-011-2168-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Duodenal Adenocarcinoma: Clinicopathologic Analysis and Implications for Treatment

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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