Outcome after surgical resection for duodenal adenocarcinoma in the UK

Solaini, Leonardo; Jamieson, Nigel B.; Metcalfe, Matthew S.; Hilal, Mohammed Abu; Soonawalla, Zahir; Davidson, Brian R; McKay, Colin; Kocher, Hemant M.; Tamburrini, Riccardo; Spoletini, Gabriele; Shamali, Awad; Thomasset, Sarah

doi:10.1002/bjs.9791

Cited by 60 publications

(83 citation statements)

References 25 publications

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“…Surgical resection is the only potentially curative treatment for this malignancy. The published literature indicates that in patients with these tumors who undergo radical resection the 5-year survival rates range from 25 to 54% [2, 5–8]. In our study, the patients who were treated with radical surgery had a 5-year survival rate of 44.1%, similar to prior studies.…”

Section: Discussionsupporting

confidence: 86%

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Prognostic Factors and Clinical Characteristics of Patients with Primary Duodenal Adenocarcinoma: A Single-Center Experience from China

Jiang

Huang

Chen

et al. 2016

BioMed Research International

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Aim. To evaluate the clinical risk factors influencing overall survival of patients with duodenal adenocarcinoma after potentially curative resection. Methods. A series of 201 patients with primary duodenal adenocarcinoma who underwent surgery from 1999 to 2014 at Chinese Medical Academic Cancer Hospital were studied by retrospective chart review and subsequent telephone follow-up. Results. Resectional surgery was performed in 138 of the 201 patients to attempt curative treatment, while 63 patients were treated with palliative surgery. Median survival of patients who underwent resectional operation was 57 months, whereas that of patients who had palliative surgery was shorter, 7 months (p < 0.001). For patients who underwent radical resection, the overall 1-, 3-, and 5-year survival rates were 87.3, 59.1, and 44.1%, respectively. Multivariate Cox regression analysis revealed that lymph node metastasis (HR 31.76, 2.14 to 470.8; p = 0.012) and vascular invasion (HR 3.75, 1.24 to 11.38; p = 0.020) were independent prognostic factors negatively associated with survival in patients undergoing curative resection. There was no survival difference between the groups treated by the pancreaticoduodenectomy (n = 20) and limited resection (n = 10) for early-stage duodenal adenocarcinoma (p = 0.704). Conclusions. Duodenal adenocarcinoma is a rare disease. Curative resection is the best treatment for appropriate patients. Lymph node metastases and vascular invasion are negative prognostic factors.

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Section: Discussionsupporting

confidence: 86%

“…Its incidence is estimated at less than 0.5 per 100,000 individuals [1]. Surgical resection is the only potentially curative treatment [2]. However, given the low prevalence of this disease in the general population and the limited number of clinical studies, there is no consensus as to the most effective treatment strategy.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors and Clinical Characteristics of Patients with Primary Duodenal Adenocarcinoma: A Single-Center Experience from China

Jiang

Huang

Chen

et al. 2016

BioMed Research International

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“…Хирургическое вмешательство является основным методом лечения для данных заболеваний. Пятилетняя выживаемость после ПДР для рака головки поджелудочной железы составляет всего 15-20%, но она выше у пациентов с раком дистального отдела общего желчного протока (20-25%), БДС (30-40%) и двенадцатиперстной кишки (50-60%) [6][7][8].…”

Section: Discussionunclassified

“…Частота рака головки поджелудочной железы увеличивается с возрастом, что в сочетании со старением человеческой популяции приводит к росту абсолютного числа пациентов старших возрастных групп. Результаты лечения рака головки поджелудочной железы даже у радикально оперированных пациентов все еще нельзя назвать удовлетворительными -5-летняя выживаемость составляет 15-20% [6][7][8]. Сочетание высокого риска операции с относительно низкими цифрами отдаленной выживаемости закономерно заставляет хирурга задаваться вопросом целесообразности ее выполнения у пожилого пациента и взвешивать все «за» и «против».…”

Section: Introductionunclassified

Short-term results of pancreatoduodenectomy in patients over 70 years old

Shatveryan¹,

Chardarov²,

Nikoda³

et al. 2020

Khir. Z. im. N.I. Pirogova

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Частота опухолевых поражений периампулярной области увеличивается с возрастом, что обусловливает рост числа пациентов старших возрастных групп, которым требуется выполнение панкреатодуоденальной резекции (ПДР). Цель исследования-сравнение ближайших результатов ПДР у пациентов моложе 70 лет и старше 70 лет. Материал и методы. В исследование включены пациенты, которым выполнена ПДР по различным показаниям в период с марта 2010 по февраль 2019 г. Все пациенты разделены на две группы: моложе 70 лет и старше 70 лет. Послеоперационная летальность и частота осложнений служили первичными конечными точками исследования. Результаты. В течение 9 лет выполнено 110 ПДР. В группу пациентов моложе 70 лет (1-я) включены 93 пациента. В группу пациентов в возрасте старше 70 лет (2-я) вошли 17 пациентов. Показатели ASA (American Society of Anesthesiologists) и индекс PMP (Preoperative Mortality Predictor) во 2-й группе были выше-соответственно 3 (2-3) и 2 (1-3) балла (p=0,002) и 12 (6-15) и 6,5 (5-15) балла (p<0,001). Летальность во 2-й группе была выше (11,7 и 3,2%), но различия статистически незначимы (p=0,16). Частота всех осложнений (72 и 76%; p=1,0), «больших» осложнений grade ≥IIIa (29 и 29%), гастростаза grade B/C (17,2 и 17,6%), панкреатической фистулы grade B/C (23,6 и 35,3%; p=0,3), желчной фистулы grade B/C (7,5 и 11,8%; p=0,62), срок пребывания в стационаре после операции (22 (8-165) и 23 (9-71) койко-дня; p=0,92) в группах статически значимо не различались. Заключение. Ближайшие результаты ПДР в группах пациентов моложе 70 лет и старше 70 лет сопоставимы, несмотря на более высокие показатели ASA и PMP во 2-й группе. При отборе пациентов для ПДР (при условии резектабельности опухоли) необходимо учитывать общий статус пациентов и наличие сопутствующих заболеваний. Возраст сам по себе не является основанием для отказа от операции.

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“…However, most authors coincide that positive lymph node involvement seems to be the most important factor for longterm survival in patients after resection for ampullary adenocarcinoma [3,14,19,22].…”

Section: Type Of Complicationmentioning

confidence: 99%

Surgical Treatment of Ampullary Adenocarcinoma – Single Center Experience and a Review of Literature

et al. 2018

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SummaryBackground: Adenocarcinomas of ampulla of the Vater are relatively uncommon tumors of the gastrointestinal tract. In premalignant lesions endoscopic treatment predominate. Accord ing to some authors even early adenocarcinomas (limited to mucosa) can be solved endo scopically. In malignant lesions affect ing deeper layers (includ ing submucosa) surgical ther apy is the most important. The article summarises the current view for a surgical treatment of ampullary adenocarcinomas and presents results concern ing our group of patients. Materials and Methods: In 2012-2016 a total number of 17 patients underwent resection for a tumor of ampulla of the Vater. Patients underwent standard staging, were presented before a mul tidisciplinary committee and referred to a surgical treatment. The main measured parameters were the type of surgical procedure, 30day morbidity and mortality, histopathologic result and subsequent oncologic treatment. The Leeds Pathology Protocol was used to evaluate the specimens after pancreaticoduodenectomy (PD). Results: PD (n = 9) was a more often perfor med procedure than the transduodenal surgical ampullectomy (TSA) (n = 8). TSA predomina ted in polymorbid patients. Histological results (n = 17) established adenoma with highgrade dysplasia in 4 patients, the dia gnosis of adenocarcinoma was set in 13 patients. Eight patients underwent adjuvant oncologic ther apy (2 had adjuvant chemother apy, 6 had combination of chemoradiother apy). Conclusion: Premalignant neoplasias of ampulla of the Vater can be mostly solved by endoscopy. If endoscopic resection is not possible surgical ther apy is indica ted. PD is preferred procedure in the dia gnosis of adenocarcinoma. In highrisk and polymorbid patients, with no suspicion for a metastatic lymph nodes, TSA can be considered. Endoscopic ultrasonography is the imag ing modality of choice for local stag ing of ampulla of the Vater and has important role in decid ing between endoscopic, local surgical excision (TSA) or radi cal resection (PD). Our results confirmed rightfulness to perform TSA especially in elderly or polymorbid patients, where in histopathologic specimens evaluation in TSA procedures early T stage and more favorable grad ing predominated.

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Outcome after surgical resection for duodenal adenocarcinoma in the UK

Abstract: Resection of duodenal adenocarcinoma in specialist centres is associated with good long-term survival. Lymphovascular invasion and nodal metastases are independent prognostic indicators.

Cited by 60 publications

References 25 publications

Prognostic Factors and Clinical Characteristics of Patients with Primary Duodenal Adenocarcinoma: A Single-Center Experience from China

Prognostic Factors and Clinical Characteristics of Patients with Primary Duodenal Adenocarcinoma: A Single-Center Experience from China

Short-term results of pancreatoduodenectomy in patients over 70 years old

Surgical Treatment of Ampullary Adenocarcinoma – Single Center Experience and a Review of Literature

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