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A 40-Year Experience

Nova M. Ryder, MD; Clifford Y. Ko, MD; Oscar J. Hines, MD; Beat Gloor, MD; Howard A. Reber, MD

Arch Surg. 2000;135:1070-1074.

Hypothesis  In patients with duodenal adenocarcinoma, certain pathologic features of the tumor will have prognostic significance.

Design  Retrospective case series.

Patients  Forty-nine patients diagnosed with duodenal adenocarcinoma between 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 for all patients was 49 ± 9 months. The patients whose tumors were resected had longer survival than those who underwent palliation (mean ± SEM, 66 ± 13 months vs 18 ± 6 months, P = .02). Multivariate analysis revealed large tumor size (P = .01), transmural invasion (P = .004), and moderate to poor tumor grade (P = .03) were negatively correlated with survival. Lymph node status did not influence survival.

Conclusions  Our 40-year experience with duodenal adenocarcinoma demonstrates that large tumor size, advanced histological grade, and transmural invasion are associated with decreased survival. These results underscore the importance of early diagnosis, and suggest the presence of nodal spread is not a contraindication to resection.

From the Division of General Surgery, University of California, Los Angeles, UCLA School of Medicine, Los Angeles, Calif.

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