Comparison of clinicopathological characteristics between resected ampullary carcinoma and carcinoma of the second portion of the duodenum

Kohei Nishio; Kenjiro Kimura; Akihiro Murata; Go Ohira; Hiroji Shinkawa; Shintaro Kodai; Ryosuke Amano; Shogo Tanaka; Sadatoshi Shimizu; Shigekazu Takemura; Akishige Kanazawa; Shoji Kubo; Takeaki Ishizawa

doi:10.4240/wjgs.v14.i11.1219

Comparison of clinicopathological characteristics between resected ampullary carcinoma and carcinoma of the second portion of the duodenum

World J Gastrointest Surg. 2022 Nov 27;14(11):1219-1229. doi: 10.4240/wjgs.v14.i11.1219.

Affiliations

¹ Department of Hepato-Biliary-Pancreatic Surgery, Osaka Metropolitan University, Osaka 5458585, Japan.
² Department of Hepato-Biliary-Pancreatic Surgery, Osaka Metropolitan University, Osaka 5458585, Japan. v21873r@omu.ac.jp.
³ Department of Hepato-Biliary-Pancreatic Surgery, Osaka City General Hospital, Osaka 5340021, Japan.

Abstract

Background: Few studies compared the oncological and biological characteristics between ampullary carcinoma (AC) and cancer of the second portion of the duodenum (DC-II), although both tumors arise from anatomically close locations.

Aim: To elucidate differences in clinicopathological characteristics, especially the patterns of lymph node metastasis (LNM), between AC and DC-II.

Methods: This was a retrospective cohort study of 80 patients with AC and 27 patients with DC-II who underwent pancreaticoduodenectomy between January 1998 and December 2018 in two institutions. Clinicopathological factors, LNM patterns, and prognosis were compared between the two groups.

Results: The patients with AC and DC-II did not exhibit significant differences in 5-year overall survival (66.0% and 67.1%, respectively) and 5-year relapse-free survival (63.5% and 62.2%, respectively). Compared to the patients with DC-II, the rate of preoperative biliary drainage was higher (P = 0.042) and the rates of digestive symptoms (P = 0.0158), ulcerative-type cancer (P < 0.0001), large tumor diameter (P < 0.0001), and advanced tumor stage (P = 0.0019) were lower in the patients with AC. The LNM rates were 27.5% and 40.7% in patients with AC and DC-II, respectively, without significant difference (P = 0.23). The rates of LNM to hepatic nodes (N-He) and pyloric nodes (N-Py) were significantly higher in patients with DC-II than in those with AC (metastasis to N-HE: 18.5% and 5% in patients with DC-II and AC, respectively; P = 0.0432; metastasis to N-Py: 11.1% and 0% in patients with DC-II and AC, respectively; P = 0.0186).

Conclusion: Although there were no significant differences in the prognosis and recurrence rates between the two groups, metastases to N-He and N-Py were more frequent in patients with DC-II than in those with AC.

Keywords: Ampulla of Vater; Duodenum; Lymph node excision; Lymphatic metastasis pattern; Lymphatic metastasis station; Neoplasm; Pancreaticoduodenectomy.