The Role of Adjuvant Therapy in Duodenal Adenocarcinoma and Intestinal Subtype Ampullary Carcinoma after Curative Resection

Sarah Finton; Louisa Bolm; Martina Nebbia; Natalie Petruch; Carlos Férnandez-Del Castillo; Motaz Qadan; Keith D Lillemoe; Ulrich F Wellner; Marius Distler; Carolin Zimmermann; Jürgen Weitz; Felix Rückert; Nuh N Rahbari; Christoph Reissfelder; Gennaro Nappo; Tobias Keck; Alessandro Zerbi; Cristina R Ferrone

doi:10.1097/SLA.0000000000006129

The Role of Adjuvant Therapy in Duodenal Adenocarcinoma and Intestinal Subtype Ampullary Carcinoma after Curative Resection

Ann Surg. 2023 Oct 13. doi: 10.1097/SLA.0000000000006129. Online ahead of print.

Authors

Sarah Finton¹, Louisa Bolm^{1

2}, Martina Nebbia^{1

3}, Natalie Petruch^{1

2}, Carlos Férnandez-Del Castillo¹, Motaz Qadan¹, Keith D Lillemoe¹, Ulrich F Wellner², Marius Distler⁴, Carolin Zimmermann⁴, Jürgen Weitz⁴, Felix Rückert^{5

6}, Nuh N Rahbari⁶, Christoph Reissfelder⁶, Gennaro Nappo³, Tobias Keck², Alessandro Zerbi³, Cristina R Ferrone^{1

7}

Affiliations

¹ Department of Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
² Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany.
³ Department of Surgery, Unit of Pancreatic Surgery, Humanitas Research Hospital, Milan, Italy.
⁴ Department for Visceral, Thoracic and Vascular Surgery, University Hospital, Technical University Dresden, Dresden, Germany.
⁵ Department of Surgery, Diakonissen Hospital Speyer, Speyer, Germany.
⁶ Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
⁷ Department of Surgery, Cedars' Sinai Medical Center, Los Angeles, CA, United States.

PMID: 37830246
DOI: 10.1097/SLA.0000000000006129

Abstract

Objective: Defining the role of adjuvant therapy in duodenal adenocarcinoma (DAC) and intestinal subtype ampullary carcinoma (iAC).

Summary background data: DAC and iAC share a similar histological differentiation but the benefit of adjuvant therapy remains unclear.

Methods: Patients undergoing curative-intent surgical resection for DAC and iAC between 2010 and 2021 at five high-volume centers were included. Patient baseline, perioperative and long-term oncological outcomes were evaluated. Statistical testing was performed with SPSS 25 (IBM).

Results: A total of 136 patients with DAC and 171 with iAC were identified. Patients with DAC had more advanced tumors than those with iAC. Median overall survival (OS) in DAC patients was 101 months versus 155 months for iAC patients (P=0.098). DAC had a higher rate of local (14.1% vs. 1.2%, P<0.001) and systemic recurrence (30.4% vs. 3.5%, P<0.001). Adjuvant therapy failed to improve overall survival in all patients with DAC and iAC. For DAC, patients with perineural invasion, but not other negative prognostic factors had improved OS rates with adjuvant therapy (72 m vs. 44 m, P=0.044). IAC patients with N+ (190 m vs. 57 m, P=0.003), T3-4 (177 m vs. 59 m, P=0.050) and perineural invasion (150 m vs. 59 m, P=0.019) had improved OS rates with adjuvant therapy.

Conclusion: While adjuvant therapy fails to improve OS in all patients with DAC and iAC in the current study, it improved overall survival in DAC patients with perineural invasion and in iAC patients with T3-4 tumors, positive lymph nodes, and perineural invasion.