Received: 30 May 2017
Revised: 9 September 2017
Accepted: 18 September 2017
Duodenal localization is a negative predictor of survival after
small bowel adenocarcinoma resection: A population-based,
propensity score-matched analysis
Alexander Wilhelm MD
Christian Galata MD
Ulrich Beutner PhD
Bruno M. Schmied MD
Rene Warschkow MD, MSc
Thomas Steffen MD
Walter Brunner MD
Stefan Post MD
Lukas Marti MD
Department of Surgery, St. Claraspital Basel,
Department of Surgery, Universitätsmedizin
Mannheim, Medical Faculty Mannheim,
University of Heidelberg, Mannheim, Germany
Department of General, Visceral, Endocrine
and Transplantation Surgery, Kantonsspital St.
Gallen, St. Gallen, Switzerland
Institute of Medical Biometry and
Informatics, University of Heidelberg,
Lukas Marti, MD, Department of General,
Visceral, Endocrine and Transplantation
Surgery, Kantonsspital St. Gallen,
Rorschacherstrasse 95, 9007 St. Gallen,
Background and Objectives: This study assessed the influence of tumor localization of
small bowel adenocarcinoma on survival after surgical resection.
Methods: Patients with resected small bowel adenocarcinoma, ACJJ stage I-III, were
identified from the Surveillance, Epidemiology, and End Results database from 2004 to
2013. The impact of tumor localization on overall and cancer-specific survival was
assessed using Cox proportional hazard regression models with and without risk-
adjustment and propensity score methods.
Results: Adenocarcinoma was localized to the duodenum in 549 of 1025 patients
(53.6%). There was no time trend for duodenal localization (P = 0.514). The 5-year
cancer-specific survival rate was 48.2% (95%CI: 43.3-53.7%) for patients with
duodenal carcinoma and 66.6% (95%CI: 61.6-72.1%) for patients with cancer located
in the jejunum or ileum. Duodenal localization was associated with worse overall and
cancer-specific survival in univariable (HR = 1.73; HR = 1.81, respectively; both
P < 0.001), multivariable (HR = 1.52; HR = 1.65; both P < 0.001), and propensity
score-adjusted analyses (HR = 1.33, P = 0.012; HR = 1.50, P = 0.002). Furthermore,
young age, retrieval of more than 12 regional lymph nodes, less advanced stage, and
married matrimonial status were positive, independent prognostic factors.
Conclusions: Duodenal localization is an independent risk factor for poor survival after
resection of adenocarcinoma.
cancer, outcome, SEER database, small intestine, subsite
Small bowel neoplasms are rather rare and account for approximately
3% of all gastrointestinal tract malignancies in the US. More than 9000
new cases are reported annually.
These malignant tumors are primarily
adenocarcinomas orcarcinoids and occur at a rate of approximately 37%
each. The remaining tumors are lymphomas and stromal tumors that
account for approximately 17% and 8%, respectively.
entities are not equally distributed along the small bowel. For example,
adenocarcinomas occur more frequently in the duodenum.
Most patients suffering from adenocarcinoma of the small bowel
initially present only nonspecific symptoms. Therefore, diagnosis is
Source of financial support: none.
J Surg Oncol. 2018;117:397–408. wileyonlinelibrary.com/journal/jso © 2017 Wiley Periodicals, Inc.