• 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, and Cristina R Ferrone.
• Department of Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
• Ann. Surg. 2023 Oct 13.

ObjectiveDefining the role of adjuvant therapy in duodenal adenocarcinoma (DAC) and intestinal subtype ampullary carcinoma (iAC).Summary Background DataDAC and iAC share a similar histological differentiation but the benefit of adjuvant therapy remains unclear.MethodsPatients 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).ResultsA 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.ConclusionWhile 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.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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