Hisaoka Kazuhiko, Matsuda Satoru, Kawakubo Hirofumi, Takeuchi Masashi, Wada Takeyuki, Sekine Shigeki, Takamoto Takeshi, Tsutsui Mai, Yura Masahiro, Ishida Hiroki, Ono Yoshihiro, Kamiya Satoshi, Bando Etsuro, Nunobe Soya, Kinoshita Takahiro, Kitagawa Yuko
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Department of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan.
Ann Surg Oncol. 2025 May 8. doi: 10.1245/s10434-025-17388-5.
The optimal surgical procedure for primary duodenal cancer has not been established because of its low incidence. The purpose of this study was to examine the distribution of lymph node (LN) metastasis in duodenal bulb tumors. Specifically, in tumors with submucosal invasion, we aimed to evaluate the feasibility of distal gastrectomy with duodenal bulb resection combined with lymphadenectomy of regional gastric LNs.
Data from patients who underwent surgery for either adenocarcinoma or neuroendocrine tumors located in the duodenal bulb between 2000 and 2020 were retrospectively analyzed from five high-volume centers in Japan. Patient background, clinicopathological factors, type of surgery, distribution of LN metastasis, and long-term outcomes were evaluated.
The frequency of LN metastasis in tumors with submucosal invasion was 18%. Metastatic LNs were identified in T1b adenocarcinomas for #6, #8a, #8p, with similar results for neuroendocrine tumors. The 3-year overall survival rate for adenocarcinoma in stages T1a, T1b, and T2-4 was 100%, 81%, and 56%, respectively. Neuroendocrine tumors were 100% at all depths of invasion. Regarding LN tumors with submucosal invasion, while three patients had a recurrence, two cases were observed in distant organs without regional LNs, and one patient who underwent pancreaticoduodenectomy had metastasis in the gastric regional LNs.
For duodenal bulb tumors, based on the distribution of LN metastasis with tumors with submucosal invasion, distal gastrectomy with duodenal bulb resection and regional LN dissection is considered a curative treatment. Conversely, pancreaticoduodenectomy is recommended for tumors invading the muscularis propria and beyond.
由于原发性十二指肠癌发病率较低，其最佳手术方式尚未确定。本研究的目的是研究十二指肠球部肿瘤的淋巴结转移分布情况。具体而言，对于侵犯黏膜下层的肿瘤，我们旨在评估远端胃切除术联合十二指肠球部切除术及区域胃淋巴结清扫术的可行性。
回顾性分析了2000年至2020年间在日本五个高容量中心接受手术治疗的十二指肠球部腺癌或神经内分泌肿瘤患者的数据。评估了患者背景、临床病理因素、手术类型、淋巴结转移分布及长期预后。
侵犯黏膜下层的肿瘤淋巴结转移率为18%。在T1b期腺癌中，第6、8a、8p组淋巴结出现转移，神经内分泌肿瘤的结果相似。T1a、T1b和T2-4期腺癌的3年总生存率分别为100%、81%和56%。神经内分泌肿瘤在所有浸润深度的3年总生存率均为100%。对于侵犯黏膜下层的淋巴结肿瘤，3例患者出现复发，2例远处器官复发且无区域淋巴结转移，1例行胰十二指肠切除术的患者区域胃淋巴结出现转移。
对于十二指肠球部肿瘤，基于侵犯黏膜下层肿瘤的淋巴结转移分布情况，远端胃切除术联合十二指肠球部切除术及区域淋巴结清扫术被认为是一种根治性治疗方法。相反，对于侵犯固有肌层及更深层的肿瘤，建议行胰十二指肠切除术。
