Primary adenocarcinoma of the duodenum: Analysis of survival

Abstract

AbstractA survival analysis of 24 patients with primary adenocarcinoma of the duodenum managed at UCLA, Los Angeles, California, U.S.A. was made with reference to their pathological findings. Pancreaticoduodenectomy as a curative procedure was performed in 15 patients with 2 deaths postoperatively. Palliative surgery with either segmental duodenal resection (4 patients) or gastrojejunostomy (5 patients) had no complications. Metastatic disease to the paraduodenal nodes in close proximity of the duodenum, and distant regional nodes around the celiac axis, paraaortic region, and mesentery occurred frequently (63.6%). The extent of nodal disease significantly affected the survival of these patients (p=0.016). When the disease was confined to the paraduodenal nodes, the median survival was 16.47 months, which was less than that for those patients without nodal secondaries (median survival, 42 months) but much better than that for those who had metastasized to distant regional nodes (median survival, 5.97 months). The depth of transmural neoplastic penetration was also probably of prognostic importance since it correlated significantly with the extent of metastatic lymph nodes (p=0.04). Regardless of the paraduodenal nodal status, pancreaticoduodenectomy should be attempted for all patients with primary duodenal adenocarcinoma when careful examination has excluded regional nodal involvement and systemic dissemination.