Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic.
Department of Clinical and Molecular Pathology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2022 Sep;166(3):290-296. doi: 10.5507/bp.2021.028. Epub 2021 May 11.
The aim of this study was to evaluate symptoms, diagnostic methods, short- and long-term outcomes of surgical treatment in patients with duodenal adenocarcinoma.
A single center, retrospective, observational study of 52 consecutive patients with duodenal adenocarcinoma operated on with curative intent between 2006 - 2019. Duodenectomy as part of a hemipancreatoduodenectomy or total pancreatectomy procedure was performed for ADAC (ampullary duodenal/intestinal adenocarcinoma) or NADAC (non-ampullary duodenal adenocarcinoma).
Prevailing symptoms were obstructive jaundice in the ADAC group (P<0.0001) and bleeding in the NADAC group (P=0.005), with larger tumor size in patients with NADAC (P=0.001). Complication rate, morbidity and mortality were comparable. Primary total pancreatoduodenectomy predominated in the NADAC group, 16.6% vs. 2.9%, and salvage completion pancreatectomy in the ADAC group, 6% vs. 0%. Significant prognostic factors for OS were perineural invasion (P=0.006) and adjuvant chemotherapy (P=0.045) in the ADAC group, and for DFS the total number of resected lymph nodes (P=0.042) and lymph node ratio (P=0.031) in the NADAC group. Median OS is 21 months and 5-year survival 27.3% in the NADAC group and 41.5 months and 52% in the ADAC group.
Ampullary duodenal/intestinal adenocarcinomas are smaller than non-ampullary at diagnosis, with a higher rate of lymph node metastases, but with a better prognosis and long-term outcome in the presented cohort. Oral localisation of NADAC prevailed in the present cohort. Perineural invasion and postoperative oncological therapy are significant prognostic factors for OS in ADAC, but the total number of lymph nodes and lymph node ratio are significant prognostic factors for DFS in NADAC.
本研究旨在评估十二指肠腺癌患者的症状、诊断方法、短期和长期手术治疗结果。
对 2006 年至 2019 年间接受根治性手术的 52 例十二指肠腺癌患者进行了一项单中心回顾性观察研究。十二指肠腺癌（ADAC）或非壶腹周围十二指肠腺癌（NADAC）患者行胰十二指肠切除术或全胰切除术，部分患者行胰头十二指肠切除术或全胰切除术。
ADAC 组主要表现为梗阻性黄疸（P<0.0001），NADAC 组主要表现为出血（P=0.005），NADAC 组肿瘤较大（P=0.001）。并发症发生率、发病率和死亡率相似。NADAC 组以原发性全胰十二指肠切除术为主（16.6% vs. 2.9%），ADAC 组以挽救性胰十二指肠切除术为主（6% vs. 0%）。ADAC 组中，OS 的显著预后因素为神经周围侵犯（P=0.006）和辅助化疗（P=0.045），NADAC 组中，DFS 的显著预后因素为切除的淋巴结总数（P=0.042）和淋巴结比率（P=0.031）。NADAC 组的中位 OS 为 21 个月，5 年生存率为 27.3%，ADAC 组的中位 OS 为 41.5 个月，5 年生存率为 52%。
与非壶腹周围腺癌相比，壶腹周围腺癌在诊断时较小，但淋巴结转移率较高，但在本研究队列中，其预后和长期结果更好。在本研究队列中，NADAC 以口腔定位为主。神经周围侵犯和术后肿瘤治疗是 ADAC 患者 OS 的显著预后因素，而淋巴结总数和淋巴结比率是 NADAC 患者 DFS 的显著预后因素。
