%0 Journal Article
%T Duodenal localization is a negative predictor of survival after small bowel adenocarcinoma resection: A population-based, propensity score-matched analysis.
%A Wilhelm A
%A Galata C
%A Beutner U
%A Schmied BM
%A Warschkow R
%A Steffen T
%A Brunner W
%A Post S
%A Marti L
%J J Surg Oncol
%V 117
%N 3
%D Mar 2018
%M 29044591
%F 2.885
%R 10.1002/jso.24877
%X <B>OBJECTIVE: </B>This study assessed the influence of tumor localization of small bowel adenocarcinoma on survival after surgical resection.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>Duodenal localization is an independent risk factor for poor survival after resection of adenocarcinoma.