Abstract
Background: This study examined prognostic discrimination by lymph node staging for duodenal adenocarcinoma and compared the nodal stage–specific survival with that associated with gastric antral adenocarcinoma.
Method: Prospectively maintained databases from 1983 to 2000 were reviewed to identify 137 patients with duodenal adenocarcinoma and 545 patients with gastric antral adenocarcinoma at a single institution.
Results: R0 resection was performed for 72 patients with duodenal cancer. At least 15 lymph nodes were retrieved in 34 cases (47%). Lymph node metastasis (pN+) was detected in 31 patients (43%). With median follow-up of 36 months, the pN category was an independently significant prognostic factor (pN0, 5-year disease-specific survival of 83%, vs. pN+, 56%; P = .03). The survival difference between pN0 and pN+ was pronounced in patients with ≥15 nodes (100% vs. 47%, respectively; P = .01) but was lost in those with <15 nodes (75% vs. 64%; P = .5). For gastric antrum cancer, 331 patients had R0 resection, and ≥15 nodes were retrieved in 256 cases (77%). Lymph node metastasis was detected in 157 cases (47%). For patients with ≥15 nodes, 5-year survival with pN0 (87%) or pN+ (44%) was not significantly different from the corresponding categories for duodenal adenocarcinoma.
Conclusion: For duodenal adenocarcinoma, examination of ≥15 regional lymph nodes improved prognostic discrimination by the pN category. With accurate nodal staging, pN0 was associated with excellent prognosis. With pN+, prognosis was similar to that for gastric antral adenocarcinoma.
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Sarela, A.I., Brennan, M.F., Karpeh, M.S. et al. Adenocarcinoma of the Duodenum: Importance of Accurate Lymph Node Staging and Similarity in Outcome to Gastric Cancer. Ann Surg Oncol 11, 380–386 (2004). https://doi.org/10.1245/ASO.2004.05.021
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DOI: https://doi.org/10.1245/ASO.2004.05.021