15-Year Experience with Surgical Treatment of Duodenal Carcinoma: A Comparison of Periampullary and Extra-Ampullary Duodenal Carcinomas

Background: The aim of our study was to compare the outcomes of periampullary and extra-ampullary duodenal adenocarcinomas and segmental duodenal resection versus pancreatoduodenectomy and to evaluate prognostic factors. Methods: We performed a retrospective review of all adults treated for duodenal adenocarcinoma by operative resection at a large tertiary referral center from 1994 to 2009. Results: One hundred twenty-four patients had an operation for duodenal adenocarcinoma over a 15-year period (periampullary, n = 25, and extra-ampullary, n = 99). Ninety-nine patients (80%) underwent curative resection, including 24 (96%) with periampullary and 75 (76%) with extra-ampullary carcinomas. The average number of lymph nodes sampled was eight with segmental resection and 12 with pancreatoduodenectomy (p < 0. 001). Five-year overall survivals were 37% for the entire cohort (n = 124), 37% in the extra-ampullary group, and 38% in the periampullary group. Tumor size (p = 0. 20), positive nodes (p = 0. 60), segmental resection versus pancreatoduodenectomy (p = 0. 55), adjuvant therapy (p = 0. 23), and R ₁ versus R ₀ resection (p = 0. 21) were not associated with survival. In contrast, advanced T stage and pathologic grade were associated with poor survival. Conclusion: Extra-ampullary and periampullary duodenal adenocarcinomas have similar survival after resection. For distal duodenal tumors, survival is improved by curative resection without being compromised by limited resection. The number of lymph nodes sampled was significantly less with segmental resection than pancreatoduodenectomy.