Duodenal Adenocarcinoma: Clinicopathologic Analysis and Implications for Treatment

Background

Duodenal adenocarcinoma is a rare cancer usually studied as a group with periampullary or small bowel adenocarcinoma; therefore, its natural history is poorly understood.

Methods

Patients with duodenal adenocarcinoma were identified from a single-institution pancreaticoduodenectomy database. Patients with adenocarcinoma arising from the ampulla of Vater were excluded. Univariate and multivariate analyses were performed to identify clinicopathologic variables associated with survival and recurrence after resection.

Results

From 1984 to 2006, a total of 122 patients with duodenal adenocarcinoma underwent pancreaticoduodenectomy. Overall survival after resection was 48% at 5?years and 41% at 10?years. Five-year survival decreased as the number of lymph nodes involved by metastasis increased from 0 to 1?C3 to ??4 (68%, 58%, 17%, respectively, P?0?C0.2 to >0.2?C0.4 to >0.4 (68%, 57%, 14%, 14%, respectively, P?P?=?0.03).

Conclusions

The prognostic significance of both the absolute number and ratio of involved lymph nodes emphasizes the need for adequate lymphadenectomy to accurately stage duodenal adenocarcinoma. The mostly distant pattern of recurrence underscores the need for the development of effective systemic therapies.