Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China.
Department of Hepatobiliary & Pancreatovascular Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, China.
Asian J Surg. 2019 Jan;42(1):46-52. doi: 10.1016/j.asjsur.2018.04.005. Epub 2018 May 24.
Primary duodenal adenocarcinoma (PDAC) is a rare malignancy. The aim of this study was to evaluate the published evidence for resection with curative intent in patients with PDAC. A literature search was conducted in PubMed and EMBASE databases for eligible studies that reported 5-year overall survival (OS) after surgical resection of PDAC from January 1990 to January 2018. Independent prognostic factors related to OS were evaluated using meta-analytical techniques. Odds ratio (OR) and hazard ratio (HR) with their 95% confidence interval (CI) were calculated as appropriate. Thirty-seven observational studies comprising a total of 1728 patients who underwent resection for PDAC were reviewed. The overall 30-day postoperative mortality was 3.2% (range, 0-16.0%) and the median 5-year OS was 46.4% (range, 16.6-71.1%). Surgical resection significantly improved the prognosis as compared with the palliative therapy (OR 15.76, P < 0.001). Lymph node metastasis (HR 2.58, P < 0.001), poor tumor differentiation (HR 1.43, P = 0.05), perineural invasion (HR 2.21, P = 0.002), and lymphovascular invasion (HR 2.18, 95% CI 1.18-4.03; P = 0.01) were found to be independently associated with decreased OS after surgical resection. The present study provides evidence that surgical resection can be performed safely for PDAC patients and offers a favorable long-term outcome. Tumor-specific factors have prognostic significance.
原发性十二指肠腺癌（PDAC）是一种罕见的恶性肿瘤。本研究旨在评估有治愈意图的手术切除治疗 PDAC 患者的已有文献证据。在 PubMed 和 EMBASE 数据库中进行了文献检索，纳入了自 1990 年 1 月至 2018 年 1 月期间报道 PDAC 手术后 5 年总生存率（OS）的研究。使用荟萃分析技术评估与 OS 相关的独立预后因素。适当计算比值比（OR）和风险比（HR）及其 95%置信区间（CI）。共回顾了 37 项观察性研究，总计 1728 例 PDAC 患者接受了手术切除。总的 30 天术后死亡率为 3.2%（范围，0-16.0%），中位 5 年 OS 为 46.4%（范围，16.6-71.1%）。与姑息治疗相比，手术切除显著改善了预后（OR 15.76，P<0.001）。淋巴结转移（HR 2.58，P<0.001）、肿瘤分化差（HR 1.43，P=0.05）、神经周围侵犯（HR 2.21，P=0.002）和血管侵犯（HR 2.18，95%CI 1.18-4.03；P=0.01）与手术切除后 OS 降低独立相关。本研究提供了证据，表明手术切除可以安全地应用于 PDAC 患者，且能带来良好的长期预后。肿瘤特异性因素具有预后意义。
