Abstract
Background
Duodenal adenocarcinoma (DA) is a rare disease, and the optimal extent of lymphadenectomy and the role of limited resection remain controversial.
Objective
The aim of our study was to assess the pattern of regional lymph node spread of DA and to determine the optimal extent of resection.
Methods
A total of 65 patients who underwent curative resection for DA at our institution from 1989 through 2015 were included in this study. Clinicopathologic factors associated with long-term outcomes and the patterns of regional node spread per primary tumor location were evaluated.
Results
Fifty-one patients (78%) underwent pancreaticoduodenectomy (PD), with the remainder undergoing limited resection. The median number of retrieved lymph nodes was 24 (range 1–63) and 48% of patients had regional node metastasis. The 5-year overall survival (OS) rate was 67%. In the multivariate analysis, regional node and para-aortic lymph node metastasis were risk factors associated with poorer OS (hazard ratio [HR] 12.1 [p = 0.025], and HR 3.2 [p = 0.045], respectively). While pancreaticoduodenal (#13) and superior mesenteric (#14) lymph node stations were commonly involved by both distal and proximal DA (33 vs. 39% for #13, p = 0.39; and 33 vs. 22% for #14, p = 0.27), the pyloric lymph node station was much less involved by distal DA than proximal DA (0 vs. 37%, p = 0.036).
Conclusion
The pancreaticoduodenal lymph node station was the most commonly involved lymph node in DA, and PD should be the standard operation for DA. Segmental resection should only be reserved for patients with distal DA who are physically unfit for PD.
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References
Spira IA, Ghazi A, Wolff WI. Primary adenocarcinoma of the duodenum. Cancer. 1977;39(4):1721–26.
Kaklamanos IG, Bathe OF, Franceschi D, Camarda C, Levi J, Livingstone AS. Extent of resection in the management of duodenal adenocarcinoma. Am J Surg. 2000;179(1):37–41.
Tocchi A, Mazzoni G, Puma F, et al. Adenocarcinoma of the third and fourth portions of the duodenum: results of surgical treatment. Arch. Surg. 2003;138(1):80–85.
Sarela AI, Brennan MF, Karpeh MS, Klimstra D, Conlon KC. Adenocarcinoma of the duodenum: importance of accurate lymph node staging and similarity in outcome to gastric cancer. Ann Surg Oncol. 2004;11(4):380–86.
Lee HG, You DD, Paik KY, Heo JS, Choi SH, Choi DW. Prognostic factors for primary duodenal adenocarcinoma. World J Surg. 2008;32(10):2246–52.
Zhang S, Cui Y, Zhong B, et al. Clinicopathological characteristics and survival analysis of primary duodenal cancers: a 14-year experience in a tertiary centre in South China. Int J Colorectal Dis. 2011;26(2):219–26.
Poultsides GA, Huang LC, Cameron JL, et al. Duodenal adenocarcinoma: clinicopathologic analysis and implications for treatment. Ann Surg Oncol. 2012;19(6):1928–35.
Lee SY, Lee JH, Hwang DW, Kim SC, Park KM, Lee YJ. Long-term outcomes in patients with duodenal adenocarcinoma. ANZ J Surg. May 8 2014;84(12):970–75.
Solaini L, Jamieson NB, Metcalfe M, et al. Outcome after surgical resection for duodenal adenocarcinoma in the UK. Br J Surg. 2015;102(6):676–81.
Compton CC, Byrd DR, Garcia-Aguilar J, Kurtzman SH, Olawaiye A, Washington MK. Small Intestine. In: Compton CC, Byrd RD, Garcia-Aguilar J, Kurtzman HS, Olawaiye A, Washington KM (eds) AJCC cancer staging atlas: a companion to the seventh editions of the AJCC cancer staging manual and handbook. Springer, New York; 2012. pp. 155–67
Skandalakis JE, Skandalakis LJ, Colborn GL, Pemberton LB, Gray SW. The duodenum. Surgical anatomy. Am Surg. 1989;55(5):291–98.
Cox D. Regression models and life tables. J R Stat Soc. 1972;34:197–219.
Cecchini S, Correa-Gallego C, Desphande V, et al. Superior prognostic importance of perineural invasion vs. lymph node involvement after curative resection of duodenal adenocarcinoma. J Gastrointest Surg. 2012;16(1):113–20. discussion 120
Onkendi EO, Boostrom SY, Sarr MG, et al. 15-year experience with surgical treatment of duodenal carcinoma: a comparison of periampullary and extra-ampullary duodenal carcinomas. J Gastrointest Surg. 2012;16(4):682–91.
Cloyd JM, Norton JA, Visser BC, Poultsides GA. Does the extent of resection impact survival for duodenal adenocarcinoma? Analysis of 1,611 cases. Ann Surg Oncol. 2015;22(2):573–80.
Solaini L, Jamieson NB, Metcalfe M, et al. Outcome after surgical resection for duodenal adenocarcinoma in the UK. Br J Surg. 2015;102(6):676–81.
Leung WK, Wu MS, Kakugawa Y, et al. Screening for gastric cancer in Asia: current evidence and practice. Lancet Oncol. 2008;9(3):279–87.
Gibbs JF. Duodenal adenocarcinoma: is total lymph node sampling predictive of outcome? Ann Surg Oncol. 2004;11(4):354–55.
Kaklamanos IG, Bathe OF, Franceschi D, Camarda C, Levi J, Livingstone AS. Extent of resection in the management of duodenal adenocarcinoma. Am J Surg. 2000;179(1):37–41.
Tocchi A, Mazzoni G, Puma F, et al. Adenocarcinoma of the third and fourth portions of the duodenum: results of surgical treatment. Arch Surg. 2003;138(1):80–85.
Disclosures
Taro Sakamoto, Akio Saiura, Yoshihiro Ono, Yoshihiro Mise, Yosuke Inoue, Takeaki Ishizawa, Yu Takahashi, Hiromichi Ito declare no conflicts of interest or funding.
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Sakamoto, T., Saiura, A., Ono, Y. et al. Optimal Lymphadenectomy for Duodenal Adenocarcinoma: Does the Number Alone Matter?. Ann Surg Oncol 24, 3368–3375 (2017). https://doi.org/10.1245/s10434-017-6044-7
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DOI: https://doi.org/10.1245/s10434-017-6044-7