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15-Year Experience with Surgical Treatment of Duodenal Carcinoma: a Comparison of Periampullary and Extra-Ampullary Duodenal Carcinomas

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The aim of our study was to compare the outcomes of periampullary and extra-ampullary duodenal adenocarcinomas and segmental duodenal resection versus pancreatoduodenectomy and to evaluate prognostic factors.

Methods

We performed a retrospective review of all adults treated for duodenal adenocarcinoma by operative resection at a large tertiary referral center from 1994 to 2009.

Results

One hundred twenty-four patients had an operation for duodenal adenocarcinoma over a 15-year period (periampullary, n = 25, and extra-ampullary, n = 99). Ninety-nine patients (80%) underwent curative resection, including 24 (96%) with periampullary and 75 (76%) with extra-ampullary carcinomas. The average number of lymph nodes sampled was eight with segmental resection and 12 with pancreatoduodenectomy (p < 0.001). Five-year overall survivals were 37% for the entire cohort (n = 124), 37% in the extra-ampullary group, and 38% in the periampullary group. Tumor size (p = 0.20), positive nodes (p = 0.60), segmental resection versus pancreatoduodenectomy (p = 0.55), adjuvant therapy (p = 0.23), and R1 versus R0 resection (p = 0.21) were not associated with survival. In contrast, advanced T stage and pathologic grade were associated with poor survival.

Conclusion

Extra-ampullary and periampullary duodenal adenocarcinomas have similar survival after resection. For distal duodenal tumors, survival is improved by curative resection without being compromised by limited resection. The number of lymph nodes sampled was significantly less with segmental resection than pancreatoduodenectomy.

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Acknowledgments

We would like to thank James R. Stubbs, MD, Karafa S. Badjie, Pamela M. Johnson, and Chelsea M. Nieuwenkamp from the Department of Transfusion Medicine, Mayo Clinic, Rochester for their assistance with data collection.

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA

    Edwin O. Onkendi, Sarah Y. Boostrom, Michael G. Sarr, Michael B. Farnell, David M. Nagorney, John H. Donohue, Michael L. Kendrick, Kaye M. Reid-Lombardo & Florencia G. Que

  2. Department of Biomedical Statistics & Informatics, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA

    William S. Harmsen

Authors
  1. Edwin O. Onkendi
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  2. Sarah Y. Boostrom
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  3. Michael G. Sarr
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  4. Michael B. Farnell
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  5. David M. Nagorney
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  6. John H. Donohue
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  7. Michael L. Kendrick
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  8. Kaye M. Reid-Lombardo
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  10. Florencia G. Que
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Corresponding author

Correspondence to Florencia G. Que.

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Onkendi, E.O., Boostrom, S.Y., Sarr, M.G. et al. 15-Year Experience with Surgical Treatment of Duodenal Carcinoma: a Comparison of Periampullary and Extra-Ampullary Duodenal Carcinomas. J Gastrointest Surg 16, 682–691 (2012). https://doi.org/10.1007/s11605-011-1808-z

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  • DOI: https://doi.org/10.1007/s11605-011-1808-z

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