Long Term Oncological Outcomes of Resection for Duodenal Adenocarcinoma

Introduction: Duodenal adenocarcinoma is a rare malignancy with surgery remaining the only curative option. The aim of this study is to analyse the outcomes of surgery and identify potential prognostic factors. Methods: Retrospective observational study of patients undergoing resection of duodenal adenocarcinoma with curative intent between 2010 and 2014. Results: Twenty-five patients (8 male and 17 female) with a mean age of 63.2 ± 12.73 years underwent surgery. The majority of the patients (80%) presented with advanced tumors (Stage 2B or 3). 17 patients underwent pancreatoduodenectomy (Whipple's or PPPD), 5 underwent multivisceral resection along with vascular resection (e.g. right colon kidney or IVC), while 3 had partial duodenectomy. R0 resection was achieved in 92% of the cases. The mean overall survival was 51.4 months (95% CI: 37.22–65.59 months). Seven patients experienced recurrence with an average interval to recurrence of 8.71 months (95% CI: 0.358–17.71). Adjuvant chemotherapy offered a clear survival benefit to patients (log-rank Mantel-Cox p=0.007, 62.67 months versus 20.8 months). Although tumour differentiation did not appear to affect recurrence rates (Chi-square p = 0.952), poorly differentiated tumours tend recur earlier than moderate or well differentiated tumors. ((log-rank Mantel-Cox p = 0.039) Conclusion: Surgery with curative intent, albeit extensive, offers a survival benefit to patients with duodenal adenocarcinoma; this could be further complemented by adjuvant chemotherapy. The rarity of this tumor, necessitates larger studies to identify potential prognostic factors.