title: Outcome after surgical resection for duodenal adenocarcinoma in the UK.
abstract: BACKGROUND
  Factors influencing long-term outcome after surgical resection for duodenal adenocarcinoma are unclear.
  
  
  METHODS
  A prospectively created database was reviewed for patients undergoing surgery for duodenal adenocarcinoma in six UK hepatopancreaticobiliary centres from 2000 to 2013. Factors influencing overall survival and disease-free survival (DFS) were identified by regression analysis.
  
  
  RESULTS
  Resection with curative intent was performed in 150 (84·3 per cent) of 178 patients. The postoperative morbidity rate for these patients was 40·0 per cent and the in-hospital mortality rate was 3·3 per cent. Patients who underwent resection had a better median survival than those who had a palliative surgical procedure (84 versus 8 months; P < 0·001). The 1-, 3- and 5-year overall survival rates for patients who underwent resection were 83·9, 66·7 and 51·2 per cent respectively. Median DFS was 53 months, and 1- and 3-year DFS rates were 80·8 and 56·5 per cent respectively. Multivariable analysis revealed that node status (hazard ratio 1·73, 95 per cent c.i. 1·07 to 2·79; P = 0·006) and lymphovascular invasion (hazard ratio 3·49, 1·83 to 6·64; P = 0·003) were associated with overall survival.
  
  
  CONCLUSIONS
  Resection of duodenal adenocarcinoma in specialist centres is associated with good long-term survival. Lymphovascular invasion and nodal metastases are independent prognostic indicators.
authors.affiliation: Barts and the London HPB Centre, Royal London Hospital.
authors.forename: L
authors.initials: L
authors.lastname: Solaini
authors.forename: N B
authors.initials: NB
authors.lastname: Jamieson
authors.forename: M
authors.initials: M
authors.lastname: Metcalfe
authors.forename: M
authors.initials: M
authors.lastname: Abu Hilal
authors.forename: Z
authors.initials: Z
authors.lastname: Soonawalla
authors.forename: B R
authors.initials: BR
authors.lastname: Davidson
authors.forename: C
authors.initials: C
authors.lastname: McKay
authors.forename: H M
authors.initials: HM
authors.lastname: Kocher
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D004379:Duodenal Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology