[Clinicopathological features and surgery-related outcomes of duodenal adenocarcinoma: a multicenter retrospective study].

Objective

This multicenter retrospective study aimed to analyze the clinicopathological features of duodenal adenocarcinoma (DA) and identify prognostic factors for postoperative survival.

Methods

Demographic characteristics, clinicopathological features, treatment outcomes and survival of DA patients undergoing surgical treatment at 18 Chinese medical centers from January 2012 to December 2023 were retrospectively analyzed.

Results

Among the 2 056 DA patients included, 46.8% (963) had extra-ampullary DA (EA-DA), and 53.2% (1 093) had peri-ampullary DA (PA-DA). The 1-, 3-, and 5-year overall survival (OS) rates for patients who underwent radical surgery were 93.2%, 71.0%, and 57.2%, respectively. The median overall survival was 76 months, and the median progression-free survival (PFS) was 65 months. No differences in survival were observed between the laparotomy group and minimally invasive surgery (MIS) group either before or after propensity score matching (OS: 76 vs. 75 months before PSM, P=0.986; OS: 75 vs. 75 months after PSM, P=0.602). Furthermore, there were no significant differences between-group in operation time and postoperative complications (P＞0.05). The MIS group experienced less intraoperative blood loss and shorter hospital stays. The multivariate Cox regression analysis revealed that advanced age (HR=1.43,95% CI:1.18-1.73), elevated carbohydrate antigen 19-9 levels (HR=1.24,95% CI:1.02-1.51), perineural invasion (HR=1.44,95% CI:1.14-1.81), vascular invasion (HR=1.35,95% CI:1.07-1.71), advanced T stage (T3-4 vs. T1-2:HR=1.86,95% CI:1.49-2.31), regional lymph node metastasis (HR=1.93,95% CI:1.58-2.36), preoperative biliary drainage (HR=1.26,95% CI:1.04-1.53), intraoperative blood loss (HR=1.34,95% CI:1.11-1.62), clinically significant postoperative pancreatic fistulas (HR=1.53,95% CI:1.12-2.09), and postoperative hemorrhage (HR=1.62,95% CI:1.14-2.29) were independent risk factors for poor prognosis after surgery (all P＜0.05).

Conclusions

Radical surgery is associated with favorable overall survival among DA patients, and no difference in survival is observed between EA-DA and PA-DA patients. MIS is a reliable alternative for DA treatment.