Outcomes of duodenal adenocarcinoma—a multicenter prospective study of all patients in Sweden

Introduction

Primary duodenal adenocarcinoma is a rare disease representing only 0.5–1% of all gastrointestinal cancers. Surgery is the only curative treatment. Whether postoperative adjuvant chemotherapy is benificial is debated. The outcome of palliative treatment is scarsely researched and most studies on duodenal adenocarcinoma are hampered by small cohorts, This study aims to depict the outcome of the disease on a national level with both palliative and curative intent.

Methods

Patients with duodenal adenocarcinoma were extracted from the Swedish National registry for periampullary and pancreatic cancer (2010–2022). The cohort was divided in an early cohort (2010–2016) and a late cohort (2017–2022). Follow up was made until end of 2023. Review of patients charts was also performed.

Results

After exclusion, 657 patients were included, 40% (265 patients) recieved curative intentional treatment and 60% (392) palliative. Median survival was not met in the curative group but mean survival in curative patients was 53.6 months. Negative predictors for survival were ECOG grade 2, major complications (>3CD) and nodal positivity. Adjuvant therapy only increased survival in patients with positive nodes. In the late cohort more patients were referred to adjuvant treatment.

Patients with palliative treatment survived in mean 5.1 months with a difference between best supportive care (2.6 months) and palliative chemotherapy (9.1 months).

Discussion

This is the largest study so far demonstrating both surgical and oncological tretment in duodenal adenocarcinoma. 5-year survival rate was >50% for surgical treatment and for palliative treatment 2%. Adjuvant chemotherapy appears only useful in node positive patients that is stage >2.