Published online Mar 15, 2020. doi: 10.4251/wjgo.v12.i3.347
Peer-review started: October 21, 2019
First decision: December 5, 2019
Revised: January 4, 2020
Accepted: January 19, 2020
Article in press: January 19, 2020
Published online: March 15, 2020
Duodenal adenocarcinoma (DA) and intestinal-type papilla of Vater adenocarcinoma (it-PVA) are rare malignancies of the gastrointestinal tract. Current therapeutic options are translated nowadays from treatment strategies for patients with colorectal cancer due to histopathological similarities.
To retrospectively investigate the clinical outcome of patients with DA and it-PVA.
All patients with DA and it-PVA diagnosed between 2000 and 2017 were included at two academic centers in the Netherlands. All patients with histopathologically-confirmed DA or it-PVA were eligible for inclusion. Clinical outcome was compared between DA and it-PVA per disease stage. In the subgroup of stage IV disease, survival after local treatment of oligometastases was compared with systemic therapy or supportive care.
In total, 155 patients with DA and it-PVA were included. Patients with it-PVA more often presented with stage I disease, while DA was more often diagnosed at stage IV (P < 0.001). Of all patients, 79% were treated with curative intent. The median survival was 39 mo, and no difference in survival was found for patients with DA and it-PVA after stratification for disease stage. Seven (23%) of 31 patients with synchronous stage IV disease underwent resection of the primary tumor, combined with local treatment of oligometastases. Local treatment of metastases was associated with an overall survival of 37 mo, compared to 14 and 6 mo for systemic therapy and supportive care, respectively.
Survival of patients with DA and it-PVA is comparable per disease stage. These results suggest a potential benefit for local treatment strategies in selected patients with oligometastases, although additional prospective studies are needed.
Core tip: This study demonstrates the clinical outcome for duodenal adenocarcinoma and intestinal-type papilla of Vater adenocarcinoma, which are rare tumor types of the gastrointestinal tract. The overall survival is comparable per disease stage, resulting in a median survival of 39 mo. Most patients (79%) are treated with curative intent by surgical resection of the tumor. For patients with metastatic disease, local treatment of metastases was associated with a better overall survival compared to systemic treatment or supportive care. Future prospective studies are needed to confirm this survival benefit.