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Surgical results of non-ampullary duodenal cancer: a nationwide survey in Japan

  • Original Article—Alimentary Tract
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Abstract

Background

As non-ampullary duodenal cancer is relatively rare, the optimal treatment strategy, including the appropriate surgical procedure and efficacy of adjuvant chemotherapy, remains unclear. This nationwide survey aimed to clarify the actual lymph node spread pattern and determine the optimal treatment strategy for this disease, using a large-scale database.

Methods

We used a questionnaire and a retrospective registry of 1083 patients with non-ampullary duodenal cancer who had undergone surgery during 2008–2017 in 114 high-volume Japanese Society of Hepatobiliary and Pancreatic Surgery-certified training institutions. Propensity score-matched analyses were conducted to minimise background bias. Cox regression was performed to identify covariates associated with recurrence-free survival. There were distinct disparities in the nodal dissection rate according to the predominant tumor location and tumor invasion depth. Metastases were frequently observed in the peripancreatic nodes and those along the superior mesenteric artery, irrespective of tumor location. Their dissection seemed to be beneficial for improved survival. In the overall cohort, no survival benefit was observed in patients who received adjuvant chemotherapy when compared with that in patients who underwent surgery alone. Nevertheless, in the matched cohort, adjuvant chemotherapy for > 6 months was associated with a significant improvement in recurrence-free survival (median: 43.5 vs. 22.5 months, p = 0.016), particularly in patients with tumor invasion of the subserosa or deeper tumor invasion, lymph node metastasis, or elevated serum carbohydrate antigen 19-9 levels.

Conclusion

Pancreatoduodenectomy should be the standard procedure for advanced non-ampullary duodenal cancer. Adjuvant chemotherapy for > 6 months, especially for advanced tumors, significantly improves survival.

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Abbreviations

LR:

Local resection

PD:

Pancreatoduodenectomy

DG:

Distal gastrectomy

is/M:

Tumor in situ or tumor confined to the lamina propria

SM:

Tumor confined to the submucosa

MP:

Tumor invasion of the muscularis propria

SS:

Tumor invasion of the subserosa

SE:

Tumor invasion that is contiguous to or penetrates the serosa and is exposed to the peritoneal cavity

SI:

Tumor invasion of adjacent structures

nos.:

Number of lymph node stations

OS:

Overall survival

RFS:

Recurrence-free survival

HR:

Hazard ratio

ASA:

American Society of Anesthesiologists

CEA:

Carcinoembryonic antigen

CA19-9:

Carbohydrate antigen 19-9

CI:

Confidence interval

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Acknowledgements

We are grateful to the 114 Japanese institutions that took part in the survey. The order of these institutions listed below was determined according to the number of patients enrolled. Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research; Division of Hepatobiliary and Pancreatic Surgery, Shizuoka Cancer Center; Department of Surgery, Kansai Medical University; Department of Surgery, Kinki University Faculty of Medicine; Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University; Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine; Department of General and Gastroenterological Surgery, Osaka Medical College; Second Department of Surgery, School of Medicine, Wakayama Medical University; Department of Gastrointestinal Surgery, Tenri Hospital; Department of Surgery, The Jikei University School of Medicine; Department of Surgery, Nara Medical University; Department of Gastroenterological Surgery, Toranomon Hospital; Department of Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University; Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; Department of Surgical Oncology, Gifu University; Department of Surgery, Saitama Medical Center, Jichi Medical University; Department of Gastroenterological Surgery, Sendai Kousei Hospital; Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences; Department of Surgery, Ehime Prefectural Central Hospital; Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University; Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine; Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine; Department of Gastroenterological Surgery, Hyogo Cancer Center; Department of Surgery, Hokkaido Shokakika Hospital; Department of Gastroenterological Surgery, Ibaraki Prefectural Central Hospital; Department of Hepato‐Biliary‐Pancreatic Surgery, Osaka City General Hospital; Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East; Hepato‐Biliary‐Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo; Department of Gastroenterological Surgery, Hiroshima City Hiroshima Citizens Hospital; Department of Gastroenterological Surgery and Oncology, Kitano Hospital; Department of Surgery, Jichi Medical University; Department of Gastroenterological and General Surgery, School of Medicine, Showa University; Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine; Department of General Surgery, Toyohashi Municipal Hospital; Department of Gastroenterological Surgery, Aichi Cancer Center Hospital; Department of Hepato‐Biliary‐Pancreatic Surgery, National Hospital Organization, Fukuyama Medical Center; Department of Surgery, Katsushika Medical Center, the Jikei University School of Medicine; Second Department of Surgery, Hamamatsu University School of Medicine; Department of Surgery, Kumamoto Regional Medical Center; Department of Digestive Surgery, Osaka International Cancer Institute; Department of Surgery, Toyonaka Municipal Hospital; Department of Surgery, Division of General and Gastroenterological Surgery, Toho University School of Medicine; Department of Surgery, Fujita Health University; Department of Surgery, Osaka Red Cross Hospital; Department of Surgery, Otsu Red Cross Hospital; Department of Surgery, Kitasato University School of Medicine; Department of Surgery, Kimitsu Chuo Hospital; Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University; Department of Surgery/Gastroenterological Surgery, Nagano Municipal Hospital; Department of Surgery, Hyogo College of Medicine; Department of Surgery, Oita Prefectural Hospital; Department of Surgery, Osaka Saiseikai Nakatsu Hospital; Department of Surgery, Okayama Saiseikai General Hospital; Department of Surgery, Kurume University School of Medicine; Department of Surgery, Kochi Medical School; Department of Surgery, Iwakuni Clinical Center; Department of Surgery, Southern TOHOKU General Hospital; Department of Surgery, Musashino Red Cross Hospital; Department of Surgery, Ogaki Municipal Hospital; Department of Gastroenterological Surgery, Fukuyama City Hospital; Department of Hepato‐Biliary‐Pancreatic Surgery, National Hospital Organization Kyushu Medical Center; Department of Surgery, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center; Department of Surgery, Kobe City Medical Center General Hospital; Division of gastroenterological surgery, Saitama Cancer Center; Department of Surgery, The Jikei University School Daisan Hospital; Department of Hepatobiliary-Pancreatic Surgery, Tohoku University Graduate School of Medicine; Division of Hepato‐Biliary‐Pancreatic Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine; Department of Surgery, JA Hiroshima General Hospital; Department of Gastroenterological Surgery, Kagawa University School of Medicine; Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital; Department of Hepato‐Biliary‐Pancreatic Surgery, Tochigi Cancer Center; Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University; Department of Surgery, National Defense Medical College; Department of Surgery, Yamagata Prefectural Central Hospital; Department of Surgery, Yao Municipal Hospital; Department of Gastroenterological Surgery, Akita University Graduate School of Medicine; Department of Surgery, Iwate Medical University School of Medicine; Department of Surgery, National Hospital Organization, Osaka National Hospital; Department of Surgery, Kawasaki Municipal Hospital; Department of Surgery, Kyoto Katsura Hospital; Department of Surgery, Kyorin University School of Medicine; Department of Surgery, Keio University School of Medicine; Department of Surgery, Sakai City Medical Center; Department of Digestive and General Surgery, Faculty of Medicine, Shimane University; Department of Biliary‐Pancreatic Surgery, Fujita Health University Bantane Hospital; Department of Surgery, Toyama Prefectural Central Hospital; Department of Surgery, Iwaki City Medical Center; Department of Surgery, Kasugai Municipal Hospital; Department of Surgery, Kin-ikyo Chuo Hospital; Department of Surgery, Gunma Saiseikai Maebashi Hospital; Department of Gastroenterological Surgery, Saiseikai Suita Hospital; Department of Gastroenterological Surgery, Hakodate Municipal Hospital; Department of Gastroenterology, Shinshu University Graduate School of Medicine; Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama; Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences; Department of Gastroenterological Surgery, Hirosaki University School of Medicine; First Department of Surgery, Faculty of Medicine, University of Fukui; Department of Surgery, Matsuyama Red Cross Hospital; Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine; Department of Surgery, JA Onomichi General Hospital; Department of Surgery, Osaka Police Hospital; Department of Surgery, National Hospital Organization Nagasaki Medical Center; Department of Surgery, Nara Prefecture General Medical Center; Department of Surgery, Japanese Red Cross Maebashi Hospital; Department of Hepato‐Biliary‐Pancreatic Surgery and Transplantation, Ehime University Graduate School of Medicine; Department of Surgery, Hokkaido P.W.F.A.C. Sapporo Kosei General Hospital; Department of Surgery, Niigata Prefectural Central Hospital; Department of Surgery, Niigata Prefectural Shibata Hospital; Department of Surgery, Kansai Rosai Hospital; Department of Surgery Nagoya Central Hospital; Hepatobiliary‐Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine; Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine; First Department of Surgery, Yamagata University Graduate School of Medical Science; Department of Gastroenterological Surgery, Tokyo Medical University Ibaraki Medical Center. We also would like to express our sincere appreciation to the Japan Duodenal Cancer Guideline Committee and many doctors related to this research opportunity.

Funding

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

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Authors and Affiliations

  1. Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan

    Kenji Nakagawa, Masayuki Sho & Takahiro Akahori

  2. Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan

    Ken-ichi Okada & Hiroki Yamaue

  3. Department of Surgery, Yokohama City University, Yokohama, Japan

    Toru Aoyama

  4. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan

    Hidetoshi Eguchi

  5. Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan

    Tsutomu Fujii

  6. Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan

    Ryota Higuchi

  7. Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan

    Shingo Kanaji

  8. Department of Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan

    Kengo Kanetaka

  9. Department of Gastroenterological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan

    Shinji Kuroda

  10. Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan

    Yuichi Nagakawa

  11. Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan

    Souya Nunobe

  12. Department of Gastroenterological Surgery, Nagoya Central Hospital, Nagoya, Japan

    Suguru Yamada

  13. Department of Gastrointestinal Surgery, Nihon University Hospital, Tokyo, Japan

    Hiroharu Yamashita

  14. Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan

    Yasuhiro Kodera

Authors
  1. Kenji Nakagawa
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  2. Masayuki Sho
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  3. Ken-ichi Okada
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  4. Takahiro Akahori
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  5. Toru Aoyama
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  6. Hidetoshi Eguchi
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  7. Tsutomu Fujii
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  8. Ryota Higuchi
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  9. Shingo Kanaji
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  10. Kengo Kanetaka
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  12. Yuichi Nagakawa
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  13. Souya Nunobe
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  14. Suguru Yamada
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  15. Hiroharu Yamashita
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  16. Hiroki Yamaue
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  17. Yasuhiro Kodera
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Consortia

the Japan Duodenal Cancer Guideline Committee

Contributions

All authors equally took part in the conception of the study. KN drafted the manuscript. MS supervised the writing of the manuscript. All authors approved the final version of the manuscript and unanimously agreed to be accountable for all aspects of the work and to ensure that any questions related to the accuracy or integrity of any part of the report are appropriately investigated and resolved.

Corresponding author

Correspondence to Masayuki Sho.

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The authors have no conflicts of interest to disclose.

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Nakagawa, K., Sho, M., Okada, Ki. et al. Surgical results of non-ampullary duodenal cancer: a nationwide survey in Japan. J Gastroenterol 57, 70–81 (2022). https://doi.org/10.1007/s00535-021-01841-9

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  • DOI: https://doi.org/10.1007/s00535-021-01841-9

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