Adenocarcinoma of the duodenum: importance of accurate lymph node staging and similarity in outcome to gastric cancer.
Academic Article
Overview
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 > or =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 > or =15 nodes were retrieved in 256 cases (77%). Lymph node metastasis was detected in 157 cases (47%). For patients with > or =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 > or =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.
