What prognostic factors are important in duodenal adenocarcinoma?

Faisal G. Bakaeen, Michel M. Murr, Michael G. Sarr, Geoffrey B. Thompson, Michael B. Farnell, David M. Nagorney, David R. Farley, Jon A. Van Heerden, Lisa M. Wiersema, Cathy D. Schleck, John H. Donohue

Research output: Contribution to journalArticle

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Abstract

Hypothesis: Survival of patients with adenocarcinoma of the duodenum depends on the ability to perform a complete resection and the tumor stage. Design: Retrospective case series. Setting: Tertiary care referral center. Patients: A cohort of 101 consecutive patients (mean age, 62 years), undergoing surgery for duodenal adenocarcinoma from January 1, 1976, through December 31, 1996. Patients with ampullary carcinoma were specifically excluded. Mean duration of follow-up was 4 years. Interventions: Surgery was curative in 68 patients (67%) and palliative in 33 patients (33%). Of the curative group, 50 patients (74%) underwent radical surgery, ie, 30 (60%), pancreaticoduodenectomy; 15 (30%), pylorus-preserving pancreaticoduodenectomy; and 5 (10%), total pancreatectomy. A more limited resection procedure was used in 18 patients (26%) involving a segmental duodenal resection in 15 (83%) and a transduodenal excision in 3 (17%). Main Outcomes and Measures: Tumor recurrence, patient survival, and correlation with patient and tumor variables using univariate and multivariate analysis. Results: Actuarial 5-year survival for the curative group was 54%. Only 1 patient in the unresected group survived beyond 3 years. Nodal metastasis (P = .002), advanced tumor stage (P<.001), positive resection margin (P = .02), and weight loss (P<.001) had a significant negative impact on survival in multivariate analysis. Tumor grade, size, and location within the duodenum had no impact on survival. Patient age and tumor depth of invasion influenced survival in univariate analysis, but lost their prognostic significance in multivariate analysis. Conclusions: Metastasis to lymph nodes, advanced tumor stage, and positive resection margins are associated with decreased survival in patients with duodenal adenocarcinoma. An aggressive surgical approach that achieves complete tumor resection with negative margins should be pursued. Pancreaticoduodenectomy is usually required for cancers of the first and second portion of the duodenum. Segmental resection may be appropriate for selected patients, especially for tumors of the distal duodenum.

Original languageEnglish (US)
Pages (from-to)635-642
Number of pages8
JournalArchives of Surgery
Volume135
Issue number6
StatePublished - Jun 2000

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Adenocarcinoma
Survival
Duodenum
Neoplasms
Pancreaticoduodenectomy
Multivariate Analysis
Tertiary Care Centers
Neoplasm Metastasis
Pancreatectomy
Second Primary Neoplasms
Pylorus
Weight Loss
Lymph Nodes
Outcome Assessment (Health Care)
Carcinoma
Recurrence

ASJC Scopus subject areas

  • Surgery

Cite this

Bakaeen, F. G., Murr, M. M., Sarr, M. G., Thompson, G. B., Farnell, M. B., Nagorney, D. M., ... Donohue, J. H. (2000). What prognostic factors are important in duodenal adenocarcinoma? Archives of Surgery, 135(6), 635-642.

What prognostic factors are important in duodenal adenocarcinoma? / Bakaeen, Faisal G.; Murr, Michel M.; Sarr, Michael G.; Thompson, Geoffrey B.; Farnell, Michael B.; Nagorney, David M.; Farley, David R.; Van Heerden, Jon A.; Wiersema, Lisa M.; Schleck, Cathy D.; Donohue, John H.

In: Archives of Surgery, Vol. 135, No. 6, 06.2000, p. 635-642.

Research output: Contribution to journalArticle

Bakaeen, FG, Murr, MM, Sarr, MG, Thompson, GB, Farnell, MB, Nagorney, DM, Farley, DR, Van Heerden, JA, Wiersema, LM, Schleck, CD & Donohue, JH 2000, 'What prognostic factors are important in duodenal adenocarcinoma?', Archives of Surgery, vol. 135, no. 6, pp. 635-642.
Bakaeen FG, Murr MM, Sarr MG, Thompson GB, Farnell MB, Nagorney DM et al. What prognostic factors are important in duodenal adenocarcinoma? Archives of Surgery. 2000 Jun;135(6):635-642.
Bakaeen, Faisal G. ; Murr, Michel M. ; Sarr, Michael G. ; Thompson, Geoffrey B. ; Farnell, Michael B. ; Nagorney, David M. ; Farley, David R. ; Van Heerden, Jon A. ; Wiersema, Lisa M. ; Schleck, Cathy D. ; Donohue, John H. / What prognostic factors are important in duodenal adenocarcinoma?. In: Archives of Surgery. 2000 ; Vol. 135, No. 6. pp. 635-642.
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title = "What prognostic factors are important in duodenal adenocarcinoma?",
abstract = "Hypothesis: Survival of patients with adenocarcinoma of the duodenum depends on the ability to perform a complete resection and the tumor stage. Design: Retrospective case series. Setting: Tertiary care referral center. Patients: A cohort of 101 consecutive patients (mean age, 62 years), undergoing surgery for duodenal adenocarcinoma from January 1, 1976, through December 31, 1996. Patients with ampullary carcinoma were specifically excluded. Mean duration of follow-up was 4 years. Interventions: Surgery was curative in 68 patients (67{\%}) and palliative in 33 patients (33{\%}). Of the curative group, 50 patients (74{\%}) underwent radical surgery, ie, 30 (60{\%}), pancreaticoduodenectomy; 15 (30{\%}), pylorus-preserving pancreaticoduodenectomy; and 5 (10{\%}), total pancreatectomy. A more limited resection procedure was used in 18 patients (26{\%}) involving a segmental duodenal resection in 15 (83{\%}) and a transduodenal excision in 3 (17{\%}). Main Outcomes and Measures: Tumor recurrence, patient survival, and correlation with patient and tumor variables using univariate and multivariate analysis. Results: Actuarial 5-year survival for the curative group was 54{\%}. Only 1 patient in the unresected group survived beyond 3 years. Nodal metastasis (P = .002), advanced tumor stage (P<.001), positive resection margin (P = .02), and weight loss (P<.001) had a significant negative impact on survival in multivariate analysis. Tumor grade, size, and location within the duodenum had no impact on survival. Patient age and tumor depth of invasion influenced survival in univariate analysis, but lost their prognostic significance in multivariate analysis. Conclusions: Metastasis to lymph nodes, advanced tumor stage, and positive resection margins are associated with decreased survival in patients with duodenal adenocarcinoma. An aggressive surgical approach that achieves complete tumor resection with negative margins should be pursued. Pancreaticoduodenectomy is usually required for cancers of the first and second portion of the duodenum. Segmental resection may be appropriate for selected patients, especially for tumors of the distal duodenum.",
author = "Bakaeen, {Faisal G.} and Murr, {Michel M.} and Sarr, {Michael G.} and Thompson, {Geoffrey B.} and Farnell, {Michael B.} and Nagorney, {David M.} and Farley, {David R.} and {Van Heerden}, {Jon A.} and Wiersema, {Lisa M.} and Schleck, {Cathy D.} and Donohue, {John H.}",
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T1 - What prognostic factors are important in duodenal adenocarcinoma?

AU - Bakaeen, Faisal G.

AU - Murr, Michel M.

AU - Sarr, Michael G.

AU - Thompson, Geoffrey B.

AU - Farnell, Michael B.

AU - Nagorney, David M.

AU - Farley, David R.

AU - Van Heerden, Jon A.

AU - Wiersema, Lisa M.

AU - Schleck, Cathy D.

AU - Donohue, John H.

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N2 - Hypothesis: Survival of patients with adenocarcinoma of the duodenum depends on the ability to perform a complete resection and the tumor stage. Design: Retrospective case series. Setting: Tertiary care referral center. Patients: A cohort of 101 consecutive patients (mean age, 62 years), undergoing surgery for duodenal adenocarcinoma from January 1, 1976, through December 31, 1996. Patients with ampullary carcinoma were specifically excluded. Mean duration of follow-up was 4 years. Interventions: Surgery was curative in 68 patients (67%) and palliative in 33 patients (33%). Of the curative group, 50 patients (74%) underwent radical surgery, ie, 30 (60%), pancreaticoduodenectomy; 15 (30%), pylorus-preserving pancreaticoduodenectomy; and 5 (10%), total pancreatectomy. A more limited resection procedure was used in 18 patients (26%) involving a segmental duodenal resection in 15 (83%) and a transduodenal excision in 3 (17%). Main Outcomes and Measures: Tumor recurrence, patient survival, and correlation with patient and tumor variables using univariate and multivariate analysis. Results: Actuarial 5-year survival for the curative group was 54%. Only 1 patient in the unresected group survived beyond 3 years. Nodal metastasis (P = .002), advanced tumor stage (P<.001), positive resection margin (P = .02), and weight loss (P<.001) had a significant negative impact on survival in multivariate analysis. Tumor grade, size, and location within the duodenum had no impact on survival. Patient age and tumor depth of invasion influenced survival in univariate analysis, but lost their prognostic significance in multivariate analysis. Conclusions: Metastasis to lymph nodes, advanced tumor stage, and positive resection margins are associated with decreased survival in patients with duodenal adenocarcinoma. An aggressive surgical approach that achieves complete tumor resection with negative margins should be pursued. Pancreaticoduodenectomy is usually required for cancers of the first and second portion of the duodenum. Segmental resection may be appropriate for selected patients, especially for tumors of the distal duodenum.

AB - Hypothesis: Survival of patients with adenocarcinoma of the duodenum depends on the ability to perform a complete resection and the tumor stage. Design: Retrospective case series. Setting: Tertiary care referral center. Patients: A cohort of 101 consecutive patients (mean age, 62 years), undergoing surgery for duodenal adenocarcinoma from January 1, 1976, through December 31, 1996. Patients with ampullary carcinoma were specifically excluded. Mean duration of follow-up was 4 years. Interventions: Surgery was curative in 68 patients (67%) and palliative in 33 patients (33%). Of the curative group, 50 patients (74%) underwent radical surgery, ie, 30 (60%), pancreaticoduodenectomy; 15 (30%), pylorus-preserving pancreaticoduodenectomy; and 5 (10%), total pancreatectomy. A more limited resection procedure was used in 18 patients (26%) involving a segmental duodenal resection in 15 (83%) and a transduodenal excision in 3 (17%). Main Outcomes and Measures: Tumor recurrence, patient survival, and correlation with patient and tumor variables using univariate and multivariate analysis. Results: Actuarial 5-year survival for the curative group was 54%. Only 1 patient in the unresected group survived beyond 3 years. Nodal metastasis (P = .002), advanced tumor stage (P<.001), positive resection margin (P = .02), and weight loss (P<.001) had a significant negative impact on survival in multivariate analysis. Tumor grade, size, and location within the duodenum had no impact on survival. Patient age and tumor depth of invasion influenced survival in univariate analysis, but lost their prognostic significance in multivariate analysis. Conclusions: Metastasis to lymph nodes, advanced tumor stage, and positive resection margins are associated with decreased survival in patients with duodenal adenocarcinoma. An aggressive surgical approach that achieves complete tumor resection with negative margins should be pursued. Pancreaticoduodenectomy is usually required for cancers of the first and second portion of the duodenum. Segmental resection may be appropriate for selected patients, especially for tumors of the distal duodenum.

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