title: Does the extent of resection impact survival for duodenal adenocarcinoma? Analysis of 1,611 cases.
abstract: BACKGROUND
  Because duodenal adenocarcinoma (DA) is relatively rare, few studies have investigated the impact of resection type on long-term outcomes.
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results database was used to identify all patients between 1988 and 2010 with DA. Patients were divided into two groups based on the type of surgery received: simple resection (SR), defined as a simple removal of the primary site, and radical resection (RR), defined as removal of the primary site with a resection in continuity with other organs. Differences in disease-specific survival (DSS) and overall survival (OS) were compared.
  
  
  RESULTS
  Of the 1,611 patients included, 746 (46.3 %) underwent SR and 865 (53.7 %) underwent RR. As expected, patients undergoing RR were more likely to present with poorly differentiated and large tumors, as well as advanced stage disease. Despite greater lymph node (LN) retrieval (11.0 vs. 6.8; p < 0.0001), RR was not associated with improved survival (5-year DSS and OS rates of 52.8 and 41.3 % for SR vs. 48.8 and 37.6 % for RR; p > 0.05). On univariate Cox proportional hazards regression analysis, the type of surgery was not associated with OS (odds ratio [OR] 0.98; 95 % confidence interval [CI] 0.87-1.11). Increasing TNM stages, tumor grade, fewer LNs removed, LN ratio, and absence of radiation were associated with worse survival. After controlling for confounding factors, type of surgery still did not influence OS (OR 1.11; 95 % CI 0.97-1.27).
  
  
  CONCLUSIONS
  Radical resection (e.g., in the form of pancreaticoduodenectomy) does not appear to impact survival compared with simple segmental resection for DA.
authors.affiliation: Department of Surgery, Stanford University, Stanford, CA, USA, jcloyd@stanford.edu.
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Cloyd
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Norton
authors.forename: Brendan C
authors.initials: BC
authors.lastname: Visser
authors.forename: George A
authors.initials: GA
authors.lastname: Poultsides
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D004379:Duodenal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018426:SEER Program; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology