Clinical analysis of primary duodenal adenocarcinoma: an 11-year experience.
OBJECTIVE
The impact of obstructive jaundice (OJ) complicated by primary duodenal adenocarcinoma (PDA) on survival, and its treatment options, has rarely been mentioned in literature. The aim of the present study was to review the clinical features of PDA patients in an attempt to determine the prognostic factors and the influence of OJ on survival.


METHODS
From May 1994 to February 2005, all duodenal malignancies treated at Kaohsiung Chang Gung Memorial Hospital were reviewed. Preliminary findings were made on a total of 116 duodenal adenocarcinoma (DA) cases. After excluding metastatic DA and the papilla of Vater cancer, 23 patients (19.8%), confirmed as having PDA, were enrolled.


RESULTS
Among the 23 predominantly male patients with a mean age of 68 years, abdominal pain was the most common symptom. Major tumor origin was the second portion, and the predominantly cytological feature was moderate differentiation. Tumor-node-metastasis (TNM) cancer stage IV accounted for 47.8% of the patients, and cancer-directed surgeries (CDS) were performed on 11 patients. Seven patients experienced complications due to OJ, which could be a sign of grave prognosis predicting survival of less than 1 year. Four of the patients received internal or external biliary drainage before CDS or palliative surgeries. Cigarette smoking, cytology, TNM stage, aspartate aminotransferase (AST), OJ, and CDS were significant factors of overall survival in a univariate analysis. The independent predictors of long-term survival were CDS, TNM stage, cytology, cigarette smoking, and AST using the Cox proportional hazard model.


CONCLUSIONS
PDA patients who did not smoke and who were eligible for and received CDS had better prognostic outcomes.
Hung
Fu-Chih
FC
Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center and Chang Gung University, College of Medicine, Kaohsiung, Taiwan.
Kuo
Chung-Mou
CM
Chuah
Seng-Kee
SK
Kuo
Chung-Huang
CH
Chen
Yaw-Sen
YS
Lu
Sheng-Nan
SN
Chang Chien
Chi-Sin
CS
D000230:Adenocarcinoma / Q000150:complications* / Q000201:enzymology / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001219:Aspartate Aminotransferases / Q000097:blood; D001662:Biliary Tract Surgical Procedures; D002454:Cell Differentiation; D019992:Databases as Topic; D013505:Digestive System Surgical Procedures; D004322:Drainage; D004379:Duodenal Neoplasms / Q000150:complications* / Q000201:enzymology / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D041781:Jaundice, Obstructive / Q000150:complications* / Q000601:surgery; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D016896:Treatment Outcome
D001219:Aspartate Aminotransferases