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Limited resection vs. pancreaticoduodenectomy for primary duodenal adenocarcinoma: a systematic review and meta-analysis

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Abstract

It is well known that surgery is the mainstay treatment for duodenal adenocarcinoma. However, the optimal extent of surgery is still under debate. We aimed to systematically review and perform a meta-analysis of limited resection (LR) and pancreatoduodenectomy for patients with duodenal adenocarcinoma. A systematic electronic database search of the literature was performed using PubMed and the Cochrane Library. All studies comparing LR and pancreatoduodenectomy for patients with duodenal adenocarcinoma were selected. Long-term overall survival was considered as the primary outcome, and perioperative morbidity and mortality as the secondary outcomes. Fifteen studies with a total of 3166 patients were analyzed; 995 and 1498 patients were treated with limited resection and pancreatoduodenectomy, respectively. Eight and 7 studies scored a low and intermediate risk of publication bias, respectively. The LR group had a more favorable result than the pancreatoduodenectomy group in overall morbidity (odd ratio [OR]: 0.33, 95% confidence interval [CI] 0.17–0.65) and postoperative pancreatic fistula (OR: 0.13, 95% CI 0.04–0.43). Mortality (OR: 0.96, 95% CI 0.70–1.33) and overall survival (OR: 0.61, 95% CI 0.33–1.13) were not significantly different between the two groups, although comparison of the two groups stratified by prognostic factors, such as T categories, was not possible due to a lack of detailed data. LR showed long-term outcomes equivalent to those of pancreatoduodenectomy, while the perioperative morbidity rates were lower. LR could be an option for selected duodenal adenocarcinoma patients with appropriate location or depth of invasion, although further studies are required.

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Acknowledgements

We would like to thank the Japan Duodenal Cancer Guideline Committee and many doctors related to this research opportunity. Japan Duodenal Cancer Guideline Committee: S. N. Souya Nunobe, S. K. Shingo Kanaji, H. E. Hidetoshi Eguchi, K. O. Ken-ichi Okada, T. F. Tsutomu Fujii, Y. N. Yuichi Nagakawa, K. K. Kengo Kanetaka, H. Y. Hiroharu Yamashita, S. Y. Suguru Yamada, S. K.Shinji Kuroda, T. A. Toru Aoyama, T. A. Takahiro Akahori, K. N. Kenji Nakagawa, R. H. Ryota Higuchi, H. Y. Hiroki Yamaue, M. S. Masayuki Sho, Y. K. Yasuhiro Kodera.

Funding

This work was supported by the Health and Labor Sciences Research Grant (Grant number H29-GANTAISAKU-IPPAN-013) and JSPS KAKENHI (Grant number 18K08632). The funders had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

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Authors and Affiliations

  1. Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Pipit Burasakarn, Ryota Higuchi & Masakazu Yamamoto

  2. Division of HPB Surgery, Department of Surgery, Phramongkutklao Hospital, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand

    Pipit Burasakarn

  3. Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Souya Nunobe

  4. Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan

    Shingo Kanaji

  5. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Hidetoshi Eguchi

  6. Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan

    Ken-ichi Okada & Hiroki Yamaue

  7. Department of Surgery and Science Faculty of Medicine, Academic Assembly, University of Toyama, , 2630 Sugitani, Toyama, 930-0194, Japan

    Tsutomu Fujii

  8. Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6 Chome-1-1 Shinjuku, Shinjuku City, Tokyo, 160-8402, Japan

    Yuichi Nagakawa

  9. Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-14 Bunkyomachi, Nagasaki, Japan

    Kengo Kanetaka

  10. Department of Gastrointestinal Surgery Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan

    Hiroharu Yamashita

  11. Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan

    Suguru Yamada & Yasuhiro Kodera

  12. Gastrointestinal Surgery Center for Innovative Clinical Medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan

    Shinji Kuroda

  13. Department of Surgery, Yokohama City University, 3 Chome-9 Fukuura, Kanazawa Ward, Yokohama, Kanagawa, 236-0004, Japan

    Toru Aoyama

  14. Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan

    Takahiro Akahori, Kenji Nakagawa & Masayuki Sho

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  1. Pipit Burasakarn
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  2. Ryota Higuchi
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  3. Souya Nunobe
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  4. Shingo Kanaji
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  6. Ken-ichi Okada
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  16. Masakazu Yamamoto
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  17. Hiroki Yamaue
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  18. Masayuki Sho
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  19. Yasuhiro Kodera
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Consortia

Japan Duodenal Cancer Guideline Committee

  • S. N. Souya Nunobe
  • , S. K. Shingo Kanaji
  • , H. E. Hidetoshi Eguchi
  • , K. O. Ken-ichi Okada
  • , T. F. Tsutomu Fujii
  • , Y. N. Yuichi Nagakawa
  • , K. K. Kengo Kanetaka
  • , H. Y. Hiroharu Yamashita
  • , S. Y. Suguru Yamada
  • , S. K. Shinji Kuroda
  • , T. A. Toru Aoyama
  • , T. A. Takahiro Akahori
  • , K. N. Kenji Nakagawa
  • , R. H. Ryota Higuchi
  • , H. Y. Hiroki Yamaue
  • , M. S. Masayuki Sho
  •  & Y. K. Yasuhiro Kodera

Contributions

Study conception and design of study: RH. Duodenal Guidelines Committee, Surgery Group: SN, SK, HE, KO, TF, YN, KK, HY, SY, SK, TA, TA, KN, RH, HY, MS and YK. Organizing committee meetings and providing opportunities for making article: KO, MS and YK. Acquisition of data: SN, SK, HE, PB and RH. Analysis and interpretation of data: PB. and RH. Drafting of manuscript: PB. and RH. Critical revision of manuscript: SN, SK, HE, MY, KO, MS and YK.

Corresponding author

Correspondence to Ryota Higuchi.

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The members of the Japan Duodenal Cancer Guideline Committee are mentioned in “Acknowledgements” section

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Burasakarn, P., Higuchi, R., Nunobe, S. et al. Limited resection vs. pancreaticoduodenectomy for primary duodenal adenocarcinoma: a systematic review and meta-analysis. Int J Clin Oncol 26, 450–460 (2021). https://doi.org/10.1007/s10147-020-01840-5

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