Surgical Treatment and Outcomes of Primary Duodenal Adenocarcinoma.
- Author:
Hye Seong AHN
1
;
Jin Young JANG
;
Seung Eun LEE
;
Sung Hoon YANG
;
Khun Uk LEE
;
Sun Whe KIM
Author Information
1. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. sunkim@plaza.snu.ac.kr
- Publication Type:Original Article
- Keywords:
Duodenum;
Primary adenocarcinoma;
Survival;
Prognostic factor
- MeSH:
Adenocarcinoma*;
Duodenal Neoplasms;
Duodenum;
Early Diagnosis;
Head;
Hospital Mortality;
Humans;
Mastectomy, Segmental;
Neoplasm Metastasis;
Palliative Care;
Pancreas;
Pancreaticoduodenectomy;
Pathology, Surgical;
Retrospective Studies;
Seoul;
Surgical Procedures, Operative
- From:Journal of the Korean Surgical Society
2007;72(1):38-45
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Because of the rarity of primary duodenal adenocarcinomas, the factors affecting the management and survival of patients with this disease remain controversial. This study analyzed the nineteen-years of experience gained at one institution to define the surgical management and outcomes of patients with primary duodenal adenocarcinomas. METHODS: A retrospective review of 77 patients, who underwent surgery for a primary duodenal adenocarcinoma at Seoul National University Hospital, between May 1985 and April 2004, was undertaken. The dermographics symptoms, operative variables, surgical pathology and survival data were analyzed. RESULTS: A curative resection was performed in 40 patients (51.9%); a pancreaticoduodenectomies and/or resection of other organs, pancreas head resection with a duodenal segmentectomy and a segmental duodenectomy and resection of another organ in 37, 2 and 1, respectively. The remaining 37 patients underwent a palliative resection or bypass. The hospital mortality and complication rates were 2.6% (2 patients) and 42.9% (33 patients), respectively. The overall 5-year survival was 26.8%. The 5-year survival for the curative resection group was 42.7%, whereas that for the palliative surgery group was 0%. In a univariate analysis, nodal metastasis was found to have a significant negative impact on survival after a curative resection (P=0.028). The patients' age, sex, operative procedure, tumor size, histologic type, differentiation and tumor depth had no influence on survival. CONCLUSION: A curative resection is associated with increased survival in patients with a duodenal adenocarcinoma. Following a curative resection, nodal metastasis is an independent prognostic factor. Therefore, the early diagnosis should be sought to achieve a curative resection and increased survival. As a curative resection, a pancreaticoduodenectomy is usually required, and a segmental duodenal resection may be appropriate in selected patients, especially in early duodenum cancer.
