Primary duodenal adenocarcinoma - A 40-year experience

Hypothesis: In patients with duodenal adenocarcinoma, certain pathologic fe atures of the tumor will have prognostic significance. Design: Retrospective case series. Patients: Forty-nine patients diagnosed with duodenal adenocarcinoma betwee n 1957 and 1998. Results: The tumors of 31 (63%) of the 49 patients underwent resection, 18 (37%) had surgical palliation or underwent biopsy. Mean (+/-SEM) survival f or all patients was 49+/-9 months. The patients whose tumors were resected had longer survival than those who underwent palliation (mean+/-SEM, 66+/-1 3 months vs 18+/-6 months, P=.02). Multivariate analysis revealed large tum or size (P=.01), transmural invasion (P=.004), and moderate to poor tumor g rade (P=.03) were negatively correlated with survival. Lymph node status di d not influence survival. Conclusions: Our 40-year experience with duodenal adenocarcinoma demonstrat es that large tumor size, advanced histological grade, and transmural invas ion are associated with decreased survival. These results underscore the im portance of early diagnosis, and suggest the presence of nodal spread is no t a contraindication to resection.