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Postoperative morbidity is an additional prognostic factor after potentially curative pancreaticoduodenectomy for primary duodenal adenocarcinoma

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Abstract

Purpose

The aims of this paper were to evaluate the clinical features of patients with primary duodenal adenocarcinoma and to address the prognostic relevance of different surgical and pathological variables after potentially curative pancreaticoduodenectomy.

Methods

Patients with primary duodenal adenocarcinoma observed from 2000 through 2009 were identified from a single-institution electronic database. Univariate and multivariate analyses were performed to identify factors associated with survival.

Results

The study population consisted of 37 patients. Of these, 25 underwent pancreaticoduodenectomy, while the remaining 12 were not amenable to resection and underwent bypass operations or were given best supportive care. Overall survival after radical resection (R0) was significantly longer than after palliative surgery (180 versus 35 months, p = 0.013). On multivariate analysis, tumor grade (hazard ratio (HR) = 1.345, 95% CI = 1.28–1.91, p = 0.03) and the occurrence of postoperative or abdominal complications (HR = 1.781, 95% CI = 1.10–2.89, p = 0.037; HR = 1.878, 95% CI = 1.21–3.08, p = 0.029) were found to be significant prognostic factors for survival in patients undergoing potentially curative resection. In particular, median survival was 180 months in patients with an uneventful postoperative course and 52 months in those with abdominal complications. The 5-year overall survival rates were 100 and 60 %, respectively.

Conclusions

According to the present findings, the development of postoperative complications may be an additional prognostic factor after potentially curative pancreaticoduodenectomy for primary duodenal adenocarcinoma. This emphasizes the need for centralization to high-volume centers where an appropriate postoperative care can be delivered.

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Authors and Affiliations

  1. General Surgery B—Pancreas Institute, G.B. Rossi Hospital, Department of Surgery, University of Verona Hospital Trust, P.le L.A. Scuro 10, 37134, Verona, Italy

    Giuseppe Malleo, Alfredo Tonsi, Giovanni Marchegiani, Andrea Casarotto, Salvatore Paiella, Giovanni Butturini, Roberto Salvia & Claudio Bassi

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  1. Giuseppe Malleo
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  2. Alfredo Tonsi
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  3. Giovanni Marchegiani
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  4. Andrea Casarotto
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  5. Salvatore Paiella
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  6. Giovanni Butturini
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  7. Roberto Salvia
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  8. Claudio Bassi
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Corresponding author

Correspondence to Claudio Bassi.

Additional information

Giuseppe Malleo and Alfredo Tonsi equally contributed to the present findings and share the first authorship.

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Malleo, G., Tonsi, A., Marchegiani, G. et al. Postoperative morbidity is an additional prognostic factor after potentially curative pancreaticoduodenectomy for primary duodenal adenocarcinoma. Langenbecks Arch Surg 398, 287–294 (2013). https://doi.org/10.1007/s00423-012-0978-9

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  • DOI: https://doi.org/10.1007/s00423-012-0978-9

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