BACKGROUND/AIMS: The prognostic factors in primary duodenal adenocarcinoma remain controversial. This study evaluated the prognostic factors associated with survival in patients with primary duodenal adenocarcinoma. METHODS: From March 1996 to June 2008, the medical records of 30 patients with a final diagnosis of primary duodenal epithelial malignancy seen at two referral centers were reviewed retrospectively. The prognostic factors for survival were evaluated 6 months and 1, 2, and 5 years after the diagnosis. RESULTS: The median survival was 5.7 months. The survival rate was 46.7% (14/30), 16.7% (5/30), 10% (3/30), and 6.7% (2/30) at 6 months and 1, 2, and 5 years, respectively. Multivariate analysis showed that cancer-directed treatment, including curative surgery or chemotherapy, was a common independent risk factor at all follow-up times. Total bilirubin, cytology, and TNM stage were independent risk factors for survival at 1, 2, and 5 years. The white blood cell count was an independent risk factor at 1 year only. The actuarial probability of survival in patients undergoing cancer-directed treatment was significantly higher than in those without treatment at 6 months (71.4 vs. 25.0%, p < 0.01), 1 year (28.6 vs. 6.3%, p < 0.01), 2 years (21.4 vs. 0%, p < 0.01), and 5 years (14.3 vs. 0%, p < 0.01). CONCLUSIONS: The prognostic factors in patients with primary duodenal adenocarcinoma were total bilirubin, TNM stage, cytology, and cancer-directed treatments until the 5-year follow-up. Especially, cancer-directed treatments improved patient survival.
Adenocarcinoma/*mortality/pathology/therapy ; Adult ; Aged ; Aged, 80 and over ; Duodenal Neoplasms/*mortality/pathology/therapy ; Female ; Hospice Care ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis

PURPOSE: We undertook this study to analyze clinical features and surgical outcome of en bloc resections of the right side colon cancer directly invading duodenum and/or pancreatic head. MATERIALS AND METHODS: The records of all patients who underwent en bloc resection of duodenum and/or pancreas for right colon cancers were analyzed retrospectively. From September 1994 to September 2006, 1,016 patients underwent curative right hemicolectomy. Nine patients (0.9%) had en bloc resection of a right side colon cancer with duodenum or pancreatic head invasion. RESULTS: The median operative time was 320 minutes (range, 200-420) and the median blood loss was 700 mL (range, 100-2,000). The mean size of tumor was 6.6 cm (range, 3.2-10.7). The mean preoperative carcinoembryonic antigen (CEA) was 10.6 ng/mL (range, 0.2-50.8). There was no 30 day perioperative mortality. The median disease-free survival was 23.5 months [95% confidence interval (CI) 5.2-41.8] and the median overall survival was 28.1 months (95% CI 9.7-46.5). CONCLUSIONS: In patients with locally advanced right side colon cancer that directly invades the duodenum or pancreas can be safely resected with curative potential with minimum morbidity and mortality. Long term disease free survival can occur in a significant number of patients undergoing curative en bloc resection in this particular subset of patients.
Adult ; Aged ; Camptothecin/analogs & derivatives/pharmacology/therapeutic use ; Chemotherapy, Adjuvant ; Colonic Neoplasms/*complications/drug therapy/mortality/*surgery ; Disease-Free Survival ; Duodenal Neoplasms/drug therapy/mortality/*secondary/surgery ; Duodenum/drug effects/*pathology/surgery ; Female ; Fluorouracil/pharmacology/therapeutic use ; Humans ; Leucovorin/pharmacology/therapeutic use ; Male ; Middle Aged ; Organoplatinum Compounds/pharmacology/therapeutic use ; Pancreas/drug effects/*pathology/surgery ; Pancreatic Neoplasms/drug therapy/mortality/*secondary/surgery ; Retrospective Studies ; Treatment Outcome