Background
Nodal metastasis is a known prognostic factor for small bowel adenocarcinoma. The
goals of this study were to evaluate the number of lymph nodes (LNs) that should be
retrieved and the impact of lymph node ratio (LNR) on survival.
Methods
Surveillance, Epidemiology, and End Results was queried to identify patients with
small bowel adenocarcinoma who underwent resection from 1988 to 2010. Survival was
calculated with the Kaplan-Meier method. Multivariate analysis identified predictors
of survival.
Results
A total of 2,772 patients underwent resection with at least one node retrieved, and
this sample included equal numbers of duodenal (n = 1,387) and jejunoileal (n = 1,386) adenocarcinomas. There were 1,371 patients with no nodal metastasis (N0,
49.4%), 928 N1 (33.5%), and 474 N2 (17.1%). The median numbers of LNs examined for
duodenal and jejunoileal cancers were 9 and 8, respectively. Cut-point analysis demonstrated
that harvesting at least 9 for jejunoileal and 5 LN for duodenal cancers resulted
in the greatest survival difference. Increasing LNR at both sites was associated with
decreased overall median survival (LNR = 0, 71 months; LNR 0–0.02, 35 months; LNR
0.21–0.4, 25 months; and LNR >0.4, 16 months; P < .001). Multivariate analysis confirmed number of LNs examined, T-stage, LN positivity,
and LNR were independent predictors of survival.
Conclusion
LNR has a profound impact on survival in patients with small bowel adenocarcinoma.
To achieve adequate staging, we recommend retrieving a minimum of 5 LN for duodenal
and 9 LN for jejunoileal adenocarcinomas.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cancer statistics, 2013.CA Cancer J Clin. 2013; 63: 11-30
- Adenocarcinoma of the small bowel: presentation, prognostic factors, and outcome of 217 patients.Cancer. 2004; 101: 518-526
- Incidence and management of primary malignant small bowel cancers: a well-defined French population study.Am J Gastroenterol. 2006; 101: 2826-2832
- The American College of Surgeons Commission on Cancer and the American Cancer Society. Adenocarcinoma of the small bowel: review of the National Cancer Data Base, 1985-1995.Cancer. 1999; 86: 2693-2706
- Surgical management and outcome in primary adenocarcinoma of the small bowel.Ann Surg Oncol. 2007; 14: 2263-2269
- Characteristics of small bowel carcinoma in hereditary nonpolyposis colorectal carcinoma. International Collaborative Group on HNPCC.Cancer. 1998; 83: 240-244
- Adenocarcinoma of the small intestine complicating Crohn's disease.Gut. 1982; 23: 188-193
- Small bowel carcinoma in Crohn's disease. Distinguishing features and risk factors.Cancer. 1989; 63: 360-363
- Prognostic factors of primary small bowel adenocarcinoma: univariate and multivariate analysis.World J Surg. 2006; 30 (discussion 9): 391-398
- Duodenal adenocarcinoma: is total lymph node sampling predictive of outcome?.Ann Surg Oncol. 2004; 11: 354-355
- Small bowel adenocarcinoma: understaged and undertreated?.Ann Surg Oncol. 2010; 17: 2728-2732
- Adenocarcinoma of the duodenum: importance of accurate lymph node staging and similarity in outcome to gastric cancer.Ann Surg Oncol. 2004; 11: 380-386
- Prognostic value of lymph node evaluation in small bowel adenocarcinoma: analysis of the surveillance, epidemiology, and end results database.Cancer. 2010; 116: 5374-5382
- Prognostic relevance of lymph node ratio following pancreaticoduodenectomy for pancreatic cancer.Surgery. 2007; 141: 610-618
- Impact of total lymph node count and lymph node ratio on staging and survival after pancreatectomy for pancreatic adenocarcinoma: a large, population-based analysis.Ann Surg Oncol. 2008; 15: 165-174
- Prognostic impact of lymph node harvest and lymph node ratio in patients with colon cancer.Dis Colon Rectum. 2012; 55: 307-315
- Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors.Stat Med. 1996; 15: 361-387
- Does the extent of resection impact survival for duodenal adenocarcinoma? Analysis of 1,611 cases.Ann Surg Oncol. 2015; 22: 573-580
- Lymph node evaluation as a colon cancer quality measure: a national hospital report card.J Natl Cancer Inst. 2008; 100: 1310-1317
- Impact of nodal staging for small bowel carcinoid: more is better!.World J Endoc Surg. 2013; 5: 65-70
- Prognostic significance of the metastatic lymph node ratio in patients with gastric cancer.World J Surg. 2012; 36: 1096-1101
- Prognosis of patients with colorectal cancer is associated with lymph node ratio: a single-center analysis of 3,026 patients over a 25-year time period.Ann Surg. 2008; 248: 968-978
- A single-institution experience with 491 cases of small bowel adenocarcinoma.Am J Surg. 2010; 199: 797-803
Article info
Publication history
Published online: May 23, 2015
Accepted:
March 18,
2015
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
