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

doi:10.4240/wjgs.v14.i11.1219

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World Journal of Gastrointestinal Surgery

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1948-9366

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Retrospective Cohort Study

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

Table 1 Comparative analysis of clinicopathological factors between patients with resected cancer of the second portion of the duodenum and ampullary carcinoma

Variable	Comparison	DC-II (n = 27), %		AC (n = 80)	P value
Sex	Male	15 (55.6)	49 (61.3)	0.65
Sex	Female	12 (44.4)	31 (38.7)	0.65
Age	Median (range)	69 (41-85)	64 (37-84)	0.35
Preoperative BMI (kg/m²)	Median (range)	22.1 (16.9-27.3)	21.7 (15.8-31.3)	0.59
Preoperative mGPS	0	17	47	-
	1	5	18	-
	2	5	14	-
	0	17 (63.0)	47 (58.8)	0.82
	1-2	10 (37.0)	32 (40.0)	0.82
Preoperative biliary drainage	No	21 (77.8)	44 (55.0)	0.042
Preoperative biliary drainage	Yes	6 (22.2)	36 (45.0)	0.042
Preoperative symptoms	Absent	8 (29.6)	31 (38.7)	0.49
Preoperative symptoms	Present	19 (70.4)	49 (61.3)	0.49
Digestive symptoms	Absent	13 (48.1)	60 (75.0)	0.0158
Digestive symptoms	Present	14 (51.9)	20 (25.0)	0.0158
Anemia or tarry stool	Absent	23 (85.2)	77 (96.3)	0.06
Anemia or tarry stool	Present	4 (14.8)	3 (3.7)	0.06
Preoperative CA19-9 (U/mL)	Normal	19 (70.4)	56 (70.0)	1
Preoperative CA19-9 (U/mL)	Elevated	8 (29.6)	24 (30.0)	1
Preoperative CEA (ng/mL)	Normal	25 (92.6)	66 (82.5)	0.35
Preoperative CEA (ng/mL)	Elevated	2 (7.4)	13 (16.3)	0.35
Surgery	PD	12	38	-
	SSPPD	14	35	-
	PpPD	1	7	-
Operation time (min)	Median (range)	451 (287-837)	446.5 (266-736)	0.44
Intraoperative blood loss volume (mL)	Median (range)	685 (80-4110)	652 (150-9015)	0.48
Gross appearance	Protruding type	8 (29.6)	59 (73.8)	< 0.0001
Gross appearance	Ulcerative-type	19 (70.4)	21 (26.2)	< 0.0001
Histological grade	Pap	1	3	-
	Well	10	42	-
	Mod	13	31	-
	Por	1	4	-
	Muc	2	0	-
	Pap/well	11 (40.7)	45 (56.3)	0.19
	Mod/por/muc	16 (59.3)	35 (43.7)	0.19
Tumor diameter (mm)	Median (range)	35 (14-65)	18 (5-84)	< 0.0001
T category¹	Tis	5	23	-
	T1 (1a, 1b)	5 (4, 1)	9	-
	T2	1	28	-
	T3	5	16	-
	T4	11	4	-
	T0–T2	11 (40.7)	60 (75.0)	0.0019
	T3–T4	16 (59.3)	20 (25.0)	0.0019
N factor	N0	16	58	-
	N1	5	22	-
	N2	6	x	-
Lymph node metastasis	Absent	16 (59.3)	58 (72.5)	0.23
Lymph node metastasis	Present	11 (40.7)	22 (27.5)	0.23
Number of lymph nodes with metastasis	Median (range)	0 (0–6)	0 (0–12)	0.13
M factor	M0	24	78	0.1
M factor	M1	3	2	-
Stage	0	5	22	-
	I (A, B)	6	29 (11, 18)	-
	II A	2	4	-
	II B	3	19	-
	III (A, B)	8 (5, 3)	4	-
	IV	3	2	-
Lymphatic invasion	0	15	50	-
	1	4	12	-
	2	7	15	-
	3	1	2	-
	X	0	1	-
	0	15 (55.6)	50 (62.5)	0.5
	1-3	12 (44.4)	29 (36.3)	0.5
Venous invasion	0	20	69	-
	1	5	8	-
	2	2	2	-
	3	0	0	-
	X	0	1	-
	0	20 (74.1)	69 (86.3)	0.13
	1-3	7 (25.9)	10 (12.5)	0.13
Postoperative complication (≥ CD III)	No	18 (66.7)	42 (52.5)	0.26
Postoperative complication (≥ CD III)	Yes	9 (33.3)	38 (47.5)	0.26
Adjuvant chemotherapy	No	19 (70.4)	55 (68.8)	1
Adjuvant chemotherapy	Yes	8 (29.6)	25 (31.2)	1

¹7^th edition of the Union for International Cancer Control TNM classification.

AC: Ampullary carcinoma; BMI: Body mass index; CA19-9: Carbohydrate antigen 19-9; CD: Clavien–Dindo classification; CEA: Carcinoembryonic antigen; DC-II: Carcinoma of the second portion of the duodenum; mGPS: Modified Glasgow prognostic score; mod: moderately differentiated adenocarcinoma; muc: mucinous adenocarcinoma; pap: papillary adenocarcinoma; PD: Pancreaticoduodenectomy; poor: Poorly differentiated adenocarcinoma; PpPD: Pylorus-preserving pancreaticoduodenectomy; SSPPD: Subtotal stomach-preserving pancreatoduodenectomy; well: Well-differentiated adenocarcinoma.

Table 2 Comparison of the sites and the frequency of lymph node metastasis between the patients with cancer of the second portion of the duodenum and ampullary carcinoma

Variable	Comparison	DC-II (n = 27), %	AC (n = 80), %	P value
N-Py^a	present	3(11.1)	0 (0)	0.0186
N-Py^a	absent	23 (85.2)	73 (100)	0.0186
N-He	present	5 (18.5)	4 (5)	0.0432
N-He	absent	22 (81.5)	76 (95)	0.0432
N-SP	present	7 (25.9)	14 (17.5)	0.40
N-SP	absent	20 (74.1)	66 (82.5)	0.40
N-IP	present	3 (11.1)	10(12.5)	1.00
N-IP	absent	24 (88.9)	70 (87.5)	1.00
N-SM	present	2 (7.4)	5 (6.2)	1.00
N-SM	absent	25 (92.6)	75 (93.8)	1.00

^aPylorus-preserving pancreaticoduodenectomy excluded.

AC: Ampullary carcinoma; DC-II: Carcinoma of the second portion of the duodenum; N-He: Hepatic lymph nodes; N-IP: Inferior pancreaticoduodenal lymph nodes; N-Py: Pyloric lymph nodes; N-SM: Superior mesenteric lymph nodes; N-SP: Superior pancreaticoduodenal lymph nodes.

Table 3 Analysis of initial recurrent sites in patients with cancer of the second portion of the duodenum and ampullary carcinoma

Initial recurrent site	DC-II (n = 10), %	AC (n = 28), %	P value
Liver	2 (20.0)	6 (21.4)	1.00
Lungs	3 (30.0)	6 (21.4)	0.67
Distant lymph nodes	5 (50.0)	10 (35.7)	0.47
Peritoneal dissemination	1 (10.0)	3 (10.7)	1.00
Local	0 (0)	5 (17.9)	0.29
Others	1 (10.0)	2 (7.1)	1.00

AC: Ampullary carcinoma; DC-II: Carcinoma of the second portion of the duodenum.

Citation: Nishio K, Kimura K, Murata A, Ohira G, Shinkawa H, Kodai S, Amano R, Tanaka S, Shimizu S, Takemura S, Kanazawa A, Kubo S, Ishizawa T. Comparison of clinicopathological characteristics between resected ampullary carcinoma and carcinoma of the second portion of the duodenum. World J Gastrointest Surg 2022; 14(11): 1219-1229
URL: https://www.wjgnet.com/1948-9366/full/v14/i11/1219.htm
DOI: https://dx.doi.org/10.4240/wjgs.v14.i11.1219