title: Clinicopathological analysis and survival outcome of duodenal adenocarcinoma.
abstract: Duodenal adenocarcinoma is a rare cancer, contributing <10 % of periampullary carcinoma. This study reviews the single center experience of duodenal adenocarcinoma and analyzes the clinical and pathological factors to predict survival and recurrence. The records of 50 patients with duodenal adenocarcinoma who underwent surgical exploration or resection from 1995 to 2010 were reviewed retrospectively. Univariate and multivariate analyses were performed to identify the clinicopathological factors associated with survival and recurrence. There were 35 men and 15 women, with a mean age of 61 years. In multivariate analysis of 50 patients, R0 resection [p = 0.041, hazard ratio (HR) = 3.569, 95% confidence interval (CI) = 1.057-12.054] and symptom at initial admission (p = 0.025, HR = 11.210, 95% CI = 1.354-92.812) were independent prognostic factors for overall survival. Thirty-six patients underwent curative resection (resectability 72%). The 5-year survival rates for curative and noncurative resections were 46.4% and 0%, respectively. Univariate analysis of 36 patients who underwent R0 resection revealed that symptoms at initial admission (p = 0.023), presence of lymph node metastasis (p = 0.034), and perineural invasion (p = 0.025) were significant prognostic factors after curative resection. There was no significant factor for overall survival in the multivariate analysis. There was recurrence in 15 patients, mainly as liver metastasis. Multivariate analysis revealed that presence of symptom (p = 0.047, HR = 5.362, 95% CI = 1.021-28.149) and ulcerative tumor (p = 0.036, HR = 5.668, 95% CI = 1.123-28.619) were independent factors for disease free survival. An aggressive surgical approach to achieve R0 resection was important to enhance survival. Most of the recurrence occurred within 1 year after surgery. Close follow-up is necessary after surgical resection.
authors.affiliation: Department of Surgery, College of Medicine, Korea University, Seoul, South Korea.
authors.forename: Myung Jin
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Department of Surgery, College of Medicine, Korea University, Seoul, South Korea. Electronic address: csbroad@korea.ac.kr.
authors.forename: Sae Byeol
authors.initials: SB
authors.lastname: Choi
authors.affiliation: Department of Surgery, College of Medicine, Korea University, Seoul, South Korea.
authors.forename: Hyung Joon
authors.initials: HJ
authors.lastname: Han
authors.affiliation: Department of Surgery, College of Medicine, Korea University, Seoul, South Korea.
authors.forename: Pyoung Jae
authors.initials: PJ
authors.lastname: Park
authors.affiliation: Department of Surgery, College of Medicine, Korea University, Seoul, South Korea.
authors.forename: Wan Bae
authors.initials: WB
authors.lastname: Kim
authors.affiliation: Department of Surgery, College of Medicine, Korea University, Seoul, South Korea.
authors.forename: Tae Jin
authors.initials: TJ
authors.lastname: Song
authors.affiliation: Department of Surgery, College of Medicine, Korea University, Seoul, South Korea.
authors.forename: Sung Ock
authors.initials: SO
authors.lastname: Suh
authors.affiliation: Department of Surgery, College of Medicine, Korea University, Seoul, South Korea.
authors.forename: Sang Yong
authors.initials: SY
authors.lastname: Choi
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D004379:Duodenal Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology
keywords: Duodenal cancer; Lymph node metastasis; Pancreaticoduodenectomy; R0 resection
references.citation: World J Surg. 2008 Oct;32(10):2246-52
references.pmid: 18668288
references.citation: J Surg Oncol. 2009 Aug 1;100(2):144-8
references.pmid: 19544358
references.citation: Br J Surg. 1994 Jan;81(1):83-5
references.pmid: 7508805
references.citation: Ann Surg Oncol. 2012 Jun;19(6):1928-35
references.pmid: 22167476
references.citation: Am J Clin Oncol. 2012 Dec;35(6):533-6
references.pmid: 21659832
references.citation: J Gastroenterol Hepatol. 2007 May;22(5):724-8
references.pmid: 17444863
references.citation: Korean J Intern Med. 2011 Mar;26(1):34-40
references.pmid: 21437160
references.citation: Arch Surg. 2000 Sep;135(9):1070-4; discussion 1074-5
references.pmid: 10982512
references.citation: J Am Coll Surg. 1996 Aug;183(2):89-96
references.pmid: 8696551
references.citation: J Gastrointest Surg. 1998 Jan-Feb;2(1):79-87
references.pmid: 9841972
references.citation: Am J Gastroenterol. 2011 Feb;106(2):357-64
references.pmid: 21139577
references.citation: Arch Surg. 2000 Jun;135(6):635-41; discussion 641-2
references.pmid: 10843358