IntroductionExtra-ampullary duodenal adenocarcinoma is a rare neoplasm. The data on long-term outcomes after curative resection are limited and the role of systemic chemotherapy is not defined in these tumors. In this study, we aimed to study the prognostic factors and survival of resected primary duodenal cancers. Materials and methodsA retrospective analysis of patients with resected primary duodenal adenocarcinoma was conducted between January 2010 and December 2023. The aim of the study is to perform survival analysis and prognostic factor assessment. ResultsA total of 59 patients were included in the study. The median age was 60(33-79), and 79.7% were males. The second part of the duodenum was the most common location in 42(71.2%). Pancreaticoduodenectomy was performed in 57(96.6%) patients and 2(3.4%) had undergone segmental duodenal resection. The median lymph node harvest was 18(2-70). Adjuvant chemotherapy was administered to 39(66.1%) patients. At a median follow-up of 32(3.29-166.74) months, the 5 years OS and DFS were 55% and 49.3%; respectively. On assessment of prognostic factors, lymph node ratio (LNR) [HR 2.94(1.01-8.53)], adenocarcinoma subtype (intestinal vs non-intestinal) [HR 4.59(1.59-13.23)] and margin of resection [HR 44.24(4.02-486.19)] were significant factors for OS. ConclusionA margin-free surgical resection offers the best chance of cure in operable duodenal adenocarcinoma. Intestinal subtype and low LNR are predictors of better survival and the role of adjuvant chemotherapy remains debatable till prospective randomized trials are conducted. Data AvailabilityThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request