Adenocarinoma of the duodenum: Importance of accurate lymph node staging and similarity in outcome to gastric cancer

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 greater than or equal to15 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 greater than or equal to15 nodes were retrieved in 256 cases (77%). Lymph node metastasis was detected in 157 cases (47%). For patients with greater than or equal to15 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 greater than or equal to15 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.