15-Year Experience with Surgical Treatment of Duodenal Carcinoma

A Comparison of Periampullary and Extra-Ampullary Duodenal Carcinomas

Edwin O. Onkendi, Sarah Y. Boostrom, Michael G. Sarr, Michael B. Farnell, David M. Nagorney, John H. Donohue, Michael L. Kendrick, Kaye M. Reid-Lombardo, William S. Harmsen, Florencia Que

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)682-691
Number of pages10
JournalJournal of Gastrointestinal Surgery
Volume16
Issue number4
DOIs
StatePublished - Apr 2012

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Pancreaticoduodenectomy
Carcinoma
Adenocarcinoma
Survival
Lymph Nodes
Therapeutics
Tertiary Care Centers
Neoplasms

Keywords

  • Duodenal adenocarcinoma
  • Extra-ampullary carcinoma
  • Pancreatoduodenectomy
  • Periampullary carcinoma
  • Segmental resection

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

15-Year Experience with Surgical Treatment of Duodenal Carcinoma : A Comparison of Periampullary and Extra-Ampullary Duodenal Carcinomas. / Onkendi, Edwin O.; Boostrom, Sarah Y.; Sarr, Michael G.; Farnell, Michael B.; Nagorney, David M.; Donohue, John H.; Kendrick, Michael L.; Reid-Lombardo, Kaye M.; Harmsen, William S.; Que, Florencia.

In: Journal of Gastrointestinal Surgery, Vol. 16, No. 4, 04.2012, p. 682-691.

Research output: Contribution to journalArticle

Onkendi, EO, Boostrom, SY, Sarr, MG, Farnell, MB, Nagorney, DM, Donohue, JH, Kendrick, ML, Reid-Lombardo, KM, Harmsen, WS & Que, F 2012, '15-Year Experience with Surgical Treatment of Duodenal Carcinoma: A Comparison of Periampullary and Extra-Ampullary Duodenal Carcinomas', Journal of Gastrointestinal Surgery, vol. 16, no. 4, pp. 682-691. https://doi.org/10.1007/s11605-011-1808-z
Onkendi, Edwin O. ; Boostrom, Sarah Y. ; Sarr, Michael G. ; Farnell, Michael B. ; Nagorney, David M. ; Donohue, John H. ; Kendrick, Michael L. ; Reid-Lombardo, Kaye M. ; Harmsen, William S. ; Que, Florencia. / 15-Year Experience with Surgical Treatment of Duodenal Carcinoma : A Comparison of Periampullary and Extra-Ampullary Duodenal Carcinomas. In: Journal of Gastrointestinal Surgery. 2012 ; Vol. 16, No. 4. pp. 682-691.
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abstract = "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.",
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AU - Boostrom, Sarah Y.

AU - Sarr, Michael G.

AU - Farnell, Michael B.

AU - Nagorney, David M.

AU - Donohue, John H.

AU - Kendrick, Michael L.

AU - Reid-Lombardo, Kaye M.

AU - Harmsen, William S.

AU - Que, Florencia

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N2 - 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.

AB - 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.

KW - Duodenal adenocarcinoma

KW - Extra-ampullary carcinoma

KW - Pancreatoduodenectomy

KW - Periampullary carcinoma

KW - Segmental resection

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