What prognostic factors are important in duodenal adenocarcinoma?

Hypothesis: Survival of patients with adenocarcinoma of the duodenum depend s on the ability to perform a complete resection and the tumor stage. Design: Retrospective case series. Setting: Tertiary care referral center. Patients: A cohort of 101 consecutive patients (mean age, 62 years), underg oing surgery for duodenal adenocarcinoma from January 1, 1976, through Dece mber 31, 1996. Patients with ampullary carcinoma were specifically excluded . Mean duration of follow-up was 4 years. Interventions: Surgery was curative in 68 patients (67%) and palliative in 33 patients (33%). Of the curative group, 50 patients (74%) underwent radic al surgery, ie, 30 (60%), pancreaticoduodenectomy; 15 (30%), pylorus-preser ving pancreaticoduodenectomy; and 5 (10%), total pancreatectomy. A more lim ited resection procedure was used in 18 patients (26%) involving a segmenta l duodenal resection in 15 (83%) and a transduodenal excision in 3 (17%). Main Outcomes cmd Measures: Tumor recurrence, patient survival, and correla tion with patient and tumor variables using univariate and multivariate ana lysis. Results: Actuarial 5-year survival for the curative group was 54%. Only 1 p atient in the unresected group survived beyond 3 years. Nodal metastasis (P = .002), advanced tumor stage (P<.001), positive resection margin (P = .02 ), and weight loss (P<.001) had a significant negative impact on survival i n multivariate analysis. Tumor grade, size, and location within the duodenu m had no impact on survival. Patient age and tumor depth of invasion influe nced survival in univariate analysis, but lost their prognostic significanc e in multivariate analysis. Conclusions: Metastasis to lymph nodes, advanced tumor stage, and positive resection margins are associated with decreased survival in patients with d uodenal adenocarcinoma. An aggressive surgical approach that achieves compl ete tumor resection with negative margins should be pursued. Pancreaticoduo denectomy is usually required for cancers of the first and second portion o f the duodenum. Segmental resection may be appropriate for selected patient s, especially for tumors of the distal duodenum.