Surgical treatment of duodenal adenocarcinoma: ampullary vs. non-ampullary, short- and long-term outcomes.
ampullary carcinoma
duodenal carcinoma
long-term survival
non-ampullary carcinoma
outcomes
Journal
Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia
ISSN: 1804-7521
Titre abrégé: Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub
Pays: Czech Republic
ID NLM: 101140142
Informations de publication
Date de publication:
Sep 2022
Sep 2022
Historique:
received:
15
01
2021
accepted:
23
04
2021
pubmed:
21
5
2021
medline:
21
9
2022
entrez:
20
5
2021
Statut:
ppublish
Résumé
The aim of this study was to evaluate symptoms, diagnostic methods, short- and long-term outcomes of surgical treatment in patients with duodenal adenocarcinoma. A single center, retrospective, observational study of 52 consecutive patients with duodenal adenocarcinoma operated on with curative intent between 2006 - 2019. Duodenectomy as part of a hemipancreatoduodenectomy or total pancreatectomy procedure was performed for ADAC (ampullary duodenal/intestinal adenocarcinoma) or NADAC (non-ampullary duodenal adenocarcinoma). Prevailing symptoms were obstructive jaundice in the ADAC group (P<0.0001) and bleeding in the NADAC group (P=0.005), with larger tumor size in patients with NADAC (P=0.001). Complication rate, morbidity and mortality were comparable. Primary total pancreatoduodenectomy predominated in the NADAC group, 16.6% vs. 2.9%, and salvage completion pancreatectomy in the ADAC group, 6% vs. 0%. Significant prognostic factors for OS were perineural invasion (P=0.006) and adjuvant chemotherapy (P=0.045) in the ADAC group, and for DFS the total number of resected lymph nodes (P=0.042) and lymph node ratio (P=0.031) in the NADAC group. Median OS is 21 months and 5-year survival 27.3% in the NADAC group and 41.5 months and 52% in the ADAC group. Ampullary duodenal/intestinal adenocarcinomas are smaller than non-ampullary at diagnosis, with a higher rate of lymph node metastases, but with a better prognosis and long-term outcome in the presented cohort. Oral localisation of NADAC prevailed in the present cohort. Perineural invasion and postoperative oncological therapy are significant prognostic factors for OS in ADAC, but the total number of lymph nodes and lymph node ratio are significant prognostic factors for DFS in NADAC.
Sections du résumé
BACKGROUND
BACKGROUND
The aim of this study was to evaluate symptoms, diagnostic methods, short- and long-term outcomes of surgical treatment in patients with duodenal adenocarcinoma.
PATIENTS AND METHODS
METHODS
A single center, retrospective, observational study of 52 consecutive patients with duodenal adenocarcinoma operated on with curative intent between 2006 - 2019. Duodenectomy as part of a hemipancreatoduodenectomy or total pancreatectomy procedure was performed for ADAC (ampullary duodenal/intestinal adenocarcinoma) or NADAC (non-ampullary duodenal adenocarcinoma).
RESULTS
RESULTS
Prevailing symptoms were obstructive jaundice in the ADAC group (P<0.0001) and bleeding in the NADAC group (P=0.005), with larger tumor size in patients with NADAC (P=0.001). Complication rate, morbidity and mortality were comparable. Primary total pancreatoduodenectomy predominated in the NADAC group, 16.6% vs. 2.9%, and salvage completion pancreatectomy in the ADAC group, 6% vs. 0%. Significant prognostic factors for OS were perineural invasion (P=0.006) and adjuvant chemotherapy (P=0.045) in the ADAC group, and for DFS the total number of resected lymph nodes (P=0.042) and lymph node ratio (P=0.031) in the NADAC group. Median OS is 21 months and 5-year survival 27.3% in the NADAC group and 41.5 months and 52% in the ADAC group.
CONCLUSION
CONCLUSIONS
Ampullary duodenal/intestinal adenocarcinomas are smaller than non-ampullary at diagnosis, with a higher rate of lymph node metastases, but with a better prognosis and long-term outcome in the presented cohort. Oral localisation of NADAC prevailed in the present cohort. Perineural invasion and postoperative oncological therapy are significant prognostic factors for OS in ADAC, but the total number of lymph nodes and lymph node ratio are significant prognostic factors for DFS in NADAC.
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
290-296Déclaration de conflit d'intérêts
The authors report no conflicts of interest in this work.
Références
Chandrasegaram MD, Gill AJ, Samra J, Price T, Chen J, Fawcett J, Merrett ND. Ampullary cancer of intestinal origin and duodenal cancer - A logical clinical and therapeutic subgroup in periampullary cancer. World J Gastrointest Oncol 2017;9:407-15. doi: 10.4251/wjgo.v9.i10.407
pubmed: 29085567
doi: 10.4251/wjgo.v9.i10.407
Zenali M, Overman MJ, Rashid A, Broaddus RB, Wang H, Katz MH, Fleming JB, Abbruzzese JL, Wang H. Clinicopathologic features and prognosis of duodenal adenocarcinoma and comparison with ampullary and pancreatic ductal adenocarcinoma. Hum Pathol 2013;44:2792-8. doi: 10.1016/j.humpath.2013.07.030
pubmed: 24139211
doi: 10.1016/j.humpath.2013.07.030
Bal A, Joshi K, Vaiphei K, Wig JD. Primary duodenal neoplasms: a retrospective clinico-pathological analysis. World J Gastroenterol 2007;13:1108-11. doi: 10.3748/wjg.v13.i7.1108
pubmed: 17373748
doi: 10.3748/wjg.v13.i7.1108
Reghunath A, Kabilan K, Mittal MK. Exploring the neglected segment of the intestine: the duodenum and its pathologies. Pol J Radiol 2020;85:e230-e244. doi: 10.5114/pjr.2020.95477. PMID: 32612721; PMCID: PMC7315055.
pubmed: 32612721
doi: 10.5114/pjr.2020.95477
Adsay V, Ohike N, Tajiri T, Kim GE, Krasinskas A, Balci S, Bagci P, Basturk O, Bandyopadhyay S, Jang KT, Kooby DA, Maithel SK, Sarmiento J, Staley CA, Gonzalez RS, Kong SY, Goodman M. Ampullary region carcinomas: definition and site specific classification with delineation of four clinicopathologically and prognostically distinct subsets in an analysis of 249 cases. Am J Surg Pathol 2012;36:1592-608. doi: 10.1097/PAS.0b013e31826399d8
pubmed: 23026934
doi: 10.1097/PAS.0b013e31826399d8
Cloyd JM, George E, Visser BC. Duodenal adenocarcinoma: Advances in diagnosis and surgical management. World J Gastrointest Surg 2016;8:212-21. doi: 10.4240/wjgs.v8.i3.212
pubmed: 27022448
doi: 10.4240/wjgs.v8.i3.212
Tol JA, Gouma DJ, Bassi C, Dervenis C, Montorsi M, Adham M, Andrén-Sandberg A, Asbun HJ, Bockhorn M, Büchler MW, Conlon KC, Fernández-Cruz L, Fingerhut A, Friess H, Hartwig W, Izbicki JR, Lillemoe KD, Milicevic MN, Neoptolemos JP, Shrikhande SV, Vollmer CM, Yeo CJ, Charnley RM; International Study Group on Pancreatic Surgery. Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery 2014;156:591-600.
pubmed: 25061003
doi: 10.1016/j.surg.2014.06.016
Matsueda K, Kanzaki H, Matsueda K, Nasu J, Yoshioka M, Nakagawa M, Inoue M, Inaba T, Imagawa A, Takatani M, Takenaka R, Suzuki S, Tomoda J, Yagi T, Fujiwara T, Tanaka T, Okada H. The clinicopathological differences of sporadic non-ampullary duodenal epithelial neoplasm depending on tumor location. J Gastroenterol Hepatol 2019;34:1540-1544. doi: 10.1111/jgh.14640
pubmed: 30812050
doi: 10.1111/jgh.14640
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250:187-96. doi: 10.1097/SLA.0b013e3181b13ca2
pubmed: 19638912
doi: 10.1097/SLA.0b013e3181b13ca2
Xue Y, Vanoli A, Balci S, Reid MM, Saka B, Bagci P, Memis B, Choi H, Ohike N, Tajiri T, Muraki T, Quigley B, El-Rayes BF, Shaib W, Kooby D, Sarmiento J, Maithel SK, Knight JH, Goodman M, Krasinskas AM, Adsay V. Non-ampullary-duodenal carcinomas: clinicopathologic analysis of 47 cases and comparison with ampullary and pancreatic adenocarcinomas. Mod Pathol 2017;30:255-266. doi: 10.1038/modpathol.2016.174
pubmed: 27739441
doi: 10.1038/modpathol.2016.174
Tol JA, Brosens LA, van Dieren S, van Gulik TM, Busch OR, Besselink MG, Gouma DJ. Impact of lymph node ratio on survival in patients with pancreatic and periampullary cancer. Br J Surg 2015;102:237-45. doi: 10.1002/bjs.9709
pubmed: 25529117
doi: 10.1002/bjs.9709
Reid MD, Balci S, Ohike N, Xue Y, Kim GE, Tajiri T, Memis B, Coban I, Dolgun A, Krasinskas AM, Basturk O, Kooby DA, Sarmiento JM, Maithel SK, El-Rayes BF, Adsay V. Ampullary carcinoma is often of mixed or hybrid histologic type: an analysis of reproducibility and clinical relevance of classification as pancreatobiliary versus intestinal in 232 cases. Mod Pathol 2016;29:1575-1585. doi: 10.1038/modpathol.2016.124
pubmed: 27586202
doi: 10.1038/modpathol.2016.124
Ushiku T, Arnason T, Fukayama M, Lauwers GY. Extra-ampullary duodenal adenocarcinoma. Am J Surg Pathol 2014;38:1484-93. doi: 10.1097/PAS.0000000000000278
pubmed: 25310836
doi: 10.1097/PAS.0000000000000278
Liu N, Liang H, Zhang RP, Pan Y, Liu Y, Deng JY, Wang XN, Ding XW, Hao XS. Number of lymph node metastases: a significant prognostic factor for patients with radical resection of carcinoma of the ampulla of Vater. Zhonghua Wei Chang Wai Ke Za Zhi 2007;10:350-2.
pubmed: 17659460
Ryska M, Hrabal P. Malignang tumors of duodenum. Rozhl Chir 2015;94:497-503.
pubmed: 26767899
Yoshida M, Yabuuchi Y, Kakushima N, Kato M, Iguchi M, Yamamoto Y, Kanetaka K, Uraoka T, Fujishiro M, Sho M; Japan Duodenal Cancer Guideline Committee. The incidence of non-ampullary duodenal cancer in Japan: The first analysis of a national cancer registry. J Gastroenterol Hepatol 2020. doi: 10.1111/jgh.15285 Epub ahead of print
pubmed: 33002211
doi: 10.1111/jgh.15285
Buchbjerg T, Fristrup C, Mortensen MB. The incidence and prognosis of true duodenal carcinomas. Surg Oncol 2015;24:110-6. doi: 10.1016/j.suronc.2015.04.004
pubmed: 25936244
doi: 10.1016/j.suronc.2015.04.004
Jiang QL, Huang XH, Chen YT, Zhang JW, Wang CF. Prognostic Factors and Clinical Characteristics of Patients with Primary Duodenal Adenocarcinoma: A Single-Center Experience from China. Biomed Res Int 2016;2016:6491049. doi: 10.1155/2016/6491049
pubmed: 28116301
doi: 10.1155/2016/6491049
Nitta N, Ohgi K, Sugiura T, Okamura Y, Ito T, Yamamoto Y, Ashida R, Sasaki K, Uesaka K. Prognostic Impact of Pancreatic Invasion in Duodenal Carcinoma: A Single-Center Experience. Ann Surg Oncol 2020;27:4553-560. doi: 10.1245/s10434-020-08512-8
pubmed: 32367502
doi: 10.1245/s10434-020-08512-8
Solaini L, Jamieson NB, Metcalfe M, Abu Hilal M, Soonawalla Z, Davidson BR, McKay C, Kocher HM; UK Duodenal Cancer Study Group. Outcome after surgical resection for duodenal adenocarcinoma in the UK. Br J Surg 2015;102:676-81. doi: 10.1002/bjs.9791
pubmed: 25776995
doi: 10.1002/bjs.9791
Malleo G, Tonsi A, Marchegiani G, Casarotto A, Paiella S, Butturini G, Salvia R, Bassi C. Postoperative morbidity is an additional prognostic factor after potentially curative pancreaticoduodenectomy for primary duodenal adenocarcinoma. Langenbecks Arch Surg 2013;398:287-94. doi: 10.1007/s00423-012-0978-9
pubmed: 22801737
doi: 10.1007/s00423-012-0978-9
Kulu Y, Schmied BM, Werner J, Muselli P, Büchler MW, Schmidt J. Total pancreatectomy for pancreatic cancer: indications and operative technique. HPB (Oxford) 2009;11:469-75. doi: 10.1111/j.1477-2574.2009.00085.x
pubmed: 19816610
doi: 10.1111/j.1477-2574.2009.00085.x
Overman MJ, Kopetz S, Wen S, Hoff PM, Fogelman D, Morris J, Abbruzzese JL, Ajani JA, Wolff RA. Chemotherapy with 5-fluorouracil and a platinum compound improves outcomes in metastatic small bowel adenocarcinoma. Cancer 2008;113:2038-45. doi: 10.1002/cncr.23822
pubmed: 18759326
doi: 10.1002/cncr.23822
Overman MJ, Varadhachary GR, Kopetz S, Adinin R, Lin E, Morris JS, Eng C, Abbruzzese JL, Wolff RA. Phase II study of capecitabine and oxaliplatin for advanced adenocarcinoma of the small bowel and ampulla of Vater. J Clin Oncol 2009;27:2598-603. doi: 10.1200/JCO.2008.19.7145
pubmed: 19164203
doi: 10.1200/JCO.2008.19.7145
Lee HG, You DD, Paik KY, Heo JS, Choi SH, Choi DW. Prognostic factors for primary duodenal adenocarcinoma. World J Surg 2008;32:2246-52.
pubmed: 18668288
doi: 10.1007/s00268-008-9678-6
Gibson MK, Holcroft CA, Kvols LK, Haller D. Phase II study of 5-fluorouracil, doxorubicin, and mitomycin C for metastatic small bowel adenocarcinoma. Oncologist 2005;10:132-37.
pubmed: 15709215
doi: 10.1634/theoncologist.10-2-132
Sohn TA, Lillemoe KD, Cameron JL, Pitt HA, Kaufman HS, Hruban RH, Yeo CJ. Adenocarcinoma of the duodenum: factors influencing long-term survival. J Gastrointest Surg 1998;2:79-87. doi: 10.1016/s1091-255x(98)80107-8
pubmed: 9841972
doi: 10.1016/s1091-255x(98)80107-8
Poultsides GA, Huang LC, Cameron JL, Tuli R, Lan L, Hruban RH, Pawlik TM, Herman JM, Edil BH, Ahuja N, Choti MA, Wolfgang CL, Schulick RD. Duodenal adenocarcinoma: clinicopathologic analysis and implications for treatment. Ann Surg Oncol 2012;19:1928-35. doi: 10.1245/s10434-011-2168-3
pubmed: 22167476
doi: 10.1245/s10434-011-2168-3
Mann K, Gilbert T, Cicconi S, Jackson R, Whelan P, Campbell F, Halloran C, Neoptolemos J, Ghaneh P. Tumour stage and resection margin status are independent survival factors following partial pancreatoduodenectomy for duodenal adenocarcinoma. Langenbecks Arch Surg 2019;404:439-49. doi: 10.1007/s00423-019-01779-w
pubmed: 30972486
doi: 10.1007/s00423-019-01779-w