The Role of Neoadjuvant Versus Adjuvant Therapy for Duodenal Adenocarcinoma: A National Cancer Database Propensity Score Matched Analysis

Abstract

Introduction Adjuvant therapy is recommended in duodenal adenocarcinoma (DA), but the role of neoadjuvant therapy remains undefined. We compared the effect of neoadjuvant therapy to adjuvant therapy on overall survival, 30-day, and 90-day mortality following the resection of DA. Methods A retrospective review of the National Cancer Database was performed on patients with DA who received either adjuvant or neoadjuvant therapy in addition to surgical resection. Propensity score matching was done for patient, socioeconomic, and tumor characteristics. Overall survival, 30-day, and 90-day mortality were compared. Results A total of 112 patients were identified; 55 received adjuvant therapy; 57 received neoadjuvant therapy. There was no difference in 30-day (0% vs. 1.75%; P = 1.00), 90-day mortality (1.82% vs. 7.02%; P = .36), nor overall survival (1 yr: 86% vs. 76; 3 yr: 49% vs. 46%; 5 yr: 42% vs. 39%; P = .28). Conclusions There was no difference in overall survival after propensity score matched analysis.

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 this series, we attempted to perform bowel anastomosis with surgical ingenuity, as shown above. Although we reported nine cases, a cohesive cohort study has not yet been fully collected [9] , [10] , [11] . Nationwide or international cohort studies at multiple cancer institutions are expected.…”

“…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] .…”