Clinical outcomes of patients with duodenal adenocarcinoma and intestinal-type papilla of Vater adenocarcinoma

Meijer, Laura L.; Strijker, Marin; Bakker, Jacob K de; Toennaer, Jurgen G J; Zonderhuis, Barbara M; Vliet, Hans J. van der; Wilmink, Hanneke; Verheij, Joanne; Daams, Freek; Busch, Olivier R.; Grieken, Nicole C.T. van; Besselink, Marc G.; Kazemier, Geert

doi:10.4251/wjgo.v12.i3.347

Cited by 7 publications

(9 citation statements)

References 39 publications

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“…For example, upfront resection of oligometastatic disease may be of potential benefit specifically in patients with intestinal subtype. A previous small pilot study showed a survival benefit after resection of oligometastasis in duodenal adenocarcinoma [ 11 ]. In a retrospective single-center study including 155 patients with duodenal cancer, a median overall survival of 37 months for patients receiving local treatment of metastases versus 14 months for patients receiving systemic treatment only [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

The use of histopathological subtyping in patients with ampullary cancer: a nationwide analysis

et al. 2022

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Background Recent guidelines advise to subtype adenocarcinoma at the ampulla and papilla of Vater (here: ampullary cancer) as intestinal, pancreatobiliary, and mixed, because this has consequences for both prognosis and treatment. This nationwide study aimed to investigate how often histopathological subtyping is performed in daily clinical practice in patients with ampullary cancer. Methods Pathology reports of all patients with ampullary cancer were retrieved from the Dutch nationwide pathology database (PALGA, 1991-2020). Reports were assessed for the presence and methods used for the classification of these tumors into intestinal, pancreatobiliary, and mixed subtypes. The use of immunohistochemical markers was recorded. Results Overall, 5246 patients with ampullary cancer were included. In 1030 (19.6%) patients, a distinction between intestinal, pancreatobiliary, and mixed subtypes was made. Use of subtyping increased from 3% in 1991–1993 to 37% in 2018–2020. In 274 of the 1030 (26.6%) patients, immunohistochemistry was used to make this distinction. A gradual increase in the use of various immunohistochemical markers was seen over time since 2008, with cytokeratin 7, cytokeratin 20, and CDX2 being the most common. Staining of DPC4/SMAD4 was increasingly used since 2012. Conclusion Despite recent improvements in the use of subtyping in ampullary cancer, the distinction between intestinal, pancreatobiliary, and mixed subtypes is only made in a minority of patients. Nationwide efforts are required to standardize the pathological distinction of the various subtypes of ampullary cancer.

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Section: Discussionmentioning

confidence: 99%

The use of histopathological subtyping in patients with ampullary cancer: a nationwide analysis

et al. 2022

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“…Por lo mismo, la evidencia se limita a series de casos que describen como único tratamiento curativo la resección 8 . Los adenocarcinomas de duodeno (excluyendo los ampulomas) son aún más raros, con un mal pronóstico debido a su diagnóstico tardío 5,9,10 . Es discutible si el mejor tratamiento de un adenocarcinoma duodenal distal a la papila corresponde a una pancreatoduodenectomía o a una RDD.…”

Section: Discussionunclassified

Resección duodenal distal: Análisis de nuestra experiencia con una cirugía infrecuente.

2021

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Introducción: La resección duodenal distal (RDD) es una técnica quirúrgica compleja e infrecuente usada para el tratamiento de patologías duodenales o extraduodenales, que no comprometen la papila duodenal mayor, siendo su indicación más frecuente la patología neoplásica. Material y Métodos: Serie de pacientes sometidos a RDD entre 2009-2020 en el Hospital Clínico UC. Resultados: Total 12 pacientes, mediana de edad 56 años. Diagnóstico preoperatorio: tumores primarios duodenales (4), tumores con compromiso duodenal por contigüidad (5) y patologías de urgencia (3). El abordaje fue abierto en 9 pacientes y laparoscópico en 3 (1 caso convertido). En 9 pacientes se resecó D3-D4, en 1 paciente incluyó parte de D2 y en 2, sólo D4. La anastomosis duodenoyeyunal fue manual en 10 casos, todas con ascenso transmesocólico del asa yeyunal. Hubo 33% (n: 4) de morbilidad, todos Clavien Dindo II y 8% de mortalidad (n: 1). No hubo filtración de la anastomosis duodenoyeyunal. En el seguimiento ninguno presentó complicaciones y 4 pacientes fallecieron por progresión oncológica. Conclusión: La principal indicación quirúrgica fue patología neoplásica y en nuestra serie no hubo morbilidad mayor ni filtración anastomótica.

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“…Histopathological features, such as positive surgical margins, vascular infiltration, lymph node metastasis rate, T4 tumor staging, and distant metastasis, were independent predictors of survival. 12 (p218) , 13 (p5) , 14 Other studies have also shown that age, tumor location, tumor size, and high CEA levels in the blood may be related to prognosis. 15 , 16 Peripheral blood cell counts are associated with the survival of patients with malignant solid tumors, such as colon and gastric cancers, 17 , 18 (p342) but there is insufficient information on SBA.…”

Section: Introductionmentioning

confidence: 99%

Risk and Prognostic Factors for Small Bowel Adenocarcinoma: A Multicenter Retrospective Observational Study in China

Wei

Chen

et al. 2022

Clin Med Insights Oncol

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Background: Small bowel adenocarcinoma (SBA) is a rare malignancy that accounts for 3% of all gastrointestinal tumors. We evaluated the clinical characteristics, outcomes, and prognostic factors of primary SBAs. Methods: We retrospectively analyzed the clinicopathological features and clinical outcomes of 300 patients with SBA from three institutions in China between January 2003 and July 2020. Overall survival (OS) was analyzed using the Kaplan–Meier method and it was statistically compared using the log-rank test. Single-variable and multivariate analyses were used to identify the significant correlates of OS. Results: The primary tumor was on the duodenal papilla in 156 patients (52%), in the duodenum in 60 patients (20%), and in the jejunum–ileum in 84 patients (28%). The median OS of the entire cohort was 32.5 months (range, 0-213 months), with a 1-year OS rate of 78.0%. For jejunoileal adenocarcinoma, advanced age, advanced T stage, advanced N stage, more positive lymph nodes, distant metastasis, high carcinoembryonic antigen (CEA), and lymphocyte-to-monocyte ratio < 2.32 predicted worse survival on single-variable analysis. Multivariate analysis showed that advanced age, advanced tumor node metastases (TNM) stage, high CEA level, high alpha fetoprotein (AFP) level, and low prealbumin level were independent prognostic factors for non-ampullary SBA. The independent prognostic factors for duodenal papilla adenocarcinoma included TNM Stage III, nerve invasion, low platelet/lymphocyte ratio, and high CA19-9. Conclusion: We found different independent prognostic factors for tumors at different locations. This finding warrants further investigation to ensure more effective management strategies for SBA.

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Clinical outcomes of patients with duodenal adenocarcinoma and intestinal-type papilla of Vater adenocarcinoma

Cited by 7 publications

References 39 publications

The use of histopathological subtyping in patients with ampullary cancer: a nationwide analysis

The use of histopathological subtyping in patients with ampullary cancer: a nationwide analysis

Resección duodenal distal: Análisis de nuestra experiencia con una cirugía infrecuente.

Risk and Prognostic Factors for Small Bowel Adenocarcinoma: A Multicenter Retrospective Observational Study in China

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