title: Surgical outcomes for duodenal adenoma and adenocarcinoma: a multicentre study in Australia and the United Kingdom.
abstract: BACKGROUND
  Pancreaticoduodenectomy is often required in patients with duodenal adenoma and adenocarcinoma and these patients generally have soft pancreatic texture and small pancreatic ducts, the two most significant factors associated with post-operative pancreatic fistula (POPF). The aims of the study were to evaluate the rate of POPF and long-term outcomes for patients with duodenal adenoma and adenocarcinoma who underwent curative resection.
  
  
  METHODS
  This retrospective study (2004-2014) examined patients treated surgically with non-ampullary duodenal tumours (NADTs) in two hepatopancreaticobiliary units in Victoria, Australia, and Swansea, UK.
  
  
  RESULTS
  There were 49 resections performed including 33 pancreaticoduodenectomies, five pancreas-preserving total duodenectomies and 11 segmental duodenal resections. Median length of follow-up was 23.5 months. Final histopathology revealed 18 duodenal adenomas and 31 adenocarcinomas. POPF rate for NADTs was 28.9% (of which 54.5% were grade C) compared to 14.5% for all other pathologies. Grade C POPF was associated with poorer survival outcomes (hazard ratio = 6.73; P = 0.005). The 5-year overall survival for patients with duodenal adenocarcinoma was 66.5%.
  
  
  CONCLUSIONS
  Due to the soft pancreatic texture and small pancreatic duct, pancreatic resection for NADTs is associated with a high rate of POPF which contributes to reduced survival. Nevertheless, surgery is associated with favourable 5-year survival compared to pancreatic resection for pancreatic adenocarcinoma.
authors.affiliation: Department of Surgery (Upper Gastrointestinal - Hepatopancreaticobiliary Service), Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Chun Hin Angus
authors.identifier: http://orcid.org/0000-0002-2276-9924
authors.initials: CHA
authors.lastname: Lee
authors.affiliation: Department of Surgery (Upper Gastrointestinal - Hepatopancreaticobiliary Service), Alfred Hospital, Melbourne, Victoria, Australia.|Department of Pancreaticobiliary Surgery, Morriston Hospital, Swansea, UK.
authors.forename: Guy
authors.initials: G
authors.lastname: Shingler
authors.affiliation: Department of Pancreaticobiliary Surgery, Morriston Hospital, Swansea, UK.
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Mowbray
authors.affiliation: Department of Pancreaticobiliary Surgery, Morriston Hospital, Swansea, UK.
authors.forename: Bilal
authors.initials: B
authors.lastname: Al-Sarireh
authors.affiliation: Department of Surgery (Upper Gastrointestinal - Hepatopancreaticobiliary Service), Alfred Hospital, Melbourne, Victoria, Australia.|Victorian HepatoPancreatoBiliary Surgery Group, Cabrini Hospital, Melbourne, Victoria, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Evans
authors.affiliation: Department of Surgery (Upper Gastrointestinal - Hepatopancreaticobiliary Service), Alfred Hospital, Melbourne, Victoria, Australia.|Victorian HepatoPancreatoBiliary Surgery Group, Cabrini Hospital, Melbourne, Victoria, Australia.|Department of Upper GI/HPB Surgery, Western Hospital, Melbourne, Victoria, Australia.
authors.forename: Marty
authors.initials: M
authors.lastname: Smith
authors.affiliation: Department of Surgery (Upper Gastrointestinal - Hepatopancreaticobiliary Service), Alfred Hospital, Melbourne, Victoria, Australia.|Victorian HepatoPancreatoBiliary Surgery Group, Cabrini Hospital, Melbourne, Victoria, Australia.|Department of Upper GI/HPB Surgery, Western Hospital, Melbourne, Victoria, Australia.
authors.forename: Val
authors.initials: V
authors.lastname: Usatoff
authors.affiliation: Department of Surgery (Upper Gastrointestinal - Hepatopancreaticobiliary Service), Alfred Hospital, Melbourne, Victoria, Australia.|Victorian HepatoPancreatoBiliary Surgery Group, Cabrini Hospital, Melbourne, Victoria, Australia.
authors.forename: Charles
authors.initials: C
authors.lastname: Pilgrim
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000236:Adenoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D004379:Duodenal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000453:epidemiology*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D006113:United Kingdom
keywords: duodenal neoplasms; pancreatic fistula