Simple Versus Radical Resection for Duodenal Adenocarcinoma: A Propensity Score Matched Analysis of National Cancer Database

Abstract

Background Duodenal adenocarcinoma treatment consists of either simple or radical surgical resection. Existing evidence suggests similar survival outcomes between the two but is limited by small numbers and single-institution analysis. We aim to compare survival after partial versus radical resection for duodenal adenocarcinoma using the National Cancer Database (NCDB). Methods Using NCDB results from 2004 to 2014, we compared patients with duodenal adenocarcinoma undergoing partial resection (n = 1247) and radical resection (n = 1240) by age, sex, facility type, facility location, cancer stage, cancer grade, lymph node sampling, node status, tumor size, margin status, neoadjuvant therapy, and adjuvant therapy using chi-square analysis. Survival was compared using propensity matching. Results Patients undergoing partial resection had overall earlier cancer stage, more favorable tumor grade, and were less likely to undergo lymph node sampling and neoadjuvant therapy. When overall survival was compared between the 2 propensity-matched groups, the median survival was 46.7 months after partial resection and 43.2 months after radical resection ( P = .329), and overall survival was similar between the 2 groups ( P = .894). The use of adjuvant therapy demonstrated improved survival over either surgery alone ( P < .0001, P = .0037). Conclusion Partial resection did not demonstrate worse survival outcomes than radical resection for duodenal adenocarcinoma. The use of adjuvant therapy in addition to surgery demonstrated improved survival regardless of surgery type and played a larger role in survival than the type of surgery. Our findings provide evidence to support the continued use of both partial and radical surgical resections to treat duodenal malignancy.

Rare resected eight cases of duodenal adenocarcinomas

“…In the last decade, the diagnosis of epithelial neoplasia of the duodenum has been increased by endoscopic examination in Japan; therefore, the development of this diagnostic tool is considered to be a reason for increased findings [4] , [5] , [6] , [7] . Regardless, according to finding DC at an earlier stage that can be locally located in the duodenum, radical surgery seems to be more frequent than in previous periods according to reports and our experiences [1] , [2] , [9] , [10] , [11] , [12] , [13] , [14] , [15] . In fact, our present series of nine patients showed that the first curative case was found in 2014; therefore, preliminary evaluation of surgical treatment for DC was examined in this report.…”

“…In a recent Western series, patients with DC undergoing PD and duodenectomy were compared. The overall survival was not significantly different, although patients undergoing PD had higher morbidity [9] , [10] , [13] . However, it depends on the extension of the tumor into the parenchyma of the pancreas [17] , [18] .…”

“…Recently, JCOG1502C performed a randomized phase III trial of adjuvant chemotherapy for patients with small bowel adenocarcinoma (surgery alone vs. capecitabine and oxaliplatin) [3] . Western reports also showed that adjuvant chemotherapy led to prolonged survival of patients with DC [9] , [12] . In our series, except for stage I cases, the patients received S1 until 2017, and the modified FOLFOX6 regimen was induced at present.…”

“…Recent data have not been fully elucidated. In Western reports, DC is not rare, and many surgeries have been carried out [9] , [10] , [11] , [12] . Longer survival and many 5-year survivors might be achieved at present [9] , [13] .…”

“…In Western reports, DC is not rare, and many surgeries have been carried out [9] , [10] , [11] , [12] . Longer survival and many 5-year survivors might be achieved at present [9] , [13] . Reports regarding radical resection and the better prognosis of surgical resection compared to non-operative cases have been recently clarified [14] .…”