Copyright ©The Author(s) 2016.
World J Gastrointest Surg. Mar 27, 2016; 8(3): 212-221
Published online Mar 27, 2016. doi: 10.4240/wjgs.v8.i3.212
Table 1 Histopathologic subtypes of duodenal adenocarcinoma
PhenotypeHistological characteristicsHistologically similarImmunophenotype markersPrognosis
IntestinalTubular/cribiforming glands lined by columnar neoplastic cellsColonic adenocarcinomaMUC2, CD10, CDX2+
GastricTubular/papillary proliferation with foveolar or pyloric-type differentiationGastric adenocarcinomaMUC5AC, MUC6-
PancreaticobiliarySimple glands of cuboidal/columnar cells with rounded pleomorphic nuclei; prominent desmoplastic stromaPancreatic and Extrahepatic bile duct adenocarcinomaMUC1-
IndeterminatePoor differentiationNoneMUC1-
Table 2 7th edition of the American Joint Committee on Cancer’s staging system for small bowel adenocarcinoma
Primary tumor (T)Regional lymph nodes (N)Distant metastases (M)
Tx - Primary tumor cannot be assessedNx - Regional lymph nodes cannot be assessedMx - Distant metastases not assessed
Tis - Carcinoma in situN0 - No regional node metastasisM0 - Distant metastases not present
T1a - Tumor invades lamina propriaN1 - Metastasis in 1-3 regional nodesM1 - Distant metastases present
T1b - Tumor invades submucosaN2 - Metastasis in 4 or more regional nodes
T2 - Tumor invades muscularis propriaStage grouping
T3 - Tumor invades into the subserosaStage 0TisN0M0
Stage IT1-T2N0M0
T4 - Tumor perforates visceral peritoneum; or invades pancreas/bile ductStage IIAT3N0M0
Stage IIBT4N0M0
Stage IIIAAny TN1M0
Stage IIIBAny TN2M0
Stage IVAny TAny NM1
Table 3 Series reporting factors associated with worse survival in duodenal adenocarcinoma
Ref.Study periodTotal No. of patientsNo. of patients resected (%)PD5-year overall survivalafter resection (%)Negative predictors of survival
Solaini et al[48]2000-2013178150 (84.2)13243T stage, grade, AJCC stage, perineural invasion, size, age-Lymphovascular invasion, nodal metastasis
Poultsides et al[50]1984-2006122122 (100)12248T stage, tumor gradeTumor grade, positive margins, perineural invasion, nodal metastasis, vascular invasionNodal metastasis
Onkendi et al[79]1994-200912499 (79.8)7037Tumor size, positive nodes, surgical approach, adjuvant therapy-T stage and pathologic grade
Cecchini et al[80]1982-2010169103 (60.9)8742T stage, nodal metastasis, grade, AJCC stage, lymphovascular invasion, size, age-Perineural invasion
Liang et al[77]1993-20103636 (100)31NAT stage, grade, AJCC stage, lymphovascular invasion, perineural invasion, sizeAge > 75, body weight loss, nodal metastasisNodal metastasis
Malleo et al[73]2000-20093725 (67)25711T stage, nodal metastasis, AJCC stage, lymphovascular invasion, perineural invasion, size, age-Tumor grade, lack of post-operative complications
Zhang et al[16]1995-20089159 (65)NA491T stage, grade, AJCC stage, lymphovascular invasion, perineural invasion, size, age-Nodal metastasis, positive margins
Han et al[81]1990-20063228 (88)1830-Positive margins-
Struck et al[78]1989-20063030 (100)25332Positive margins, T stage, adjuvant therapyNodal metastasis, stage
Lee et al[74]1995-20075328 (53)2644Age, gender, weight loss, CA19-9, grade, tumor sizeT stage, nodal metastasis, AJCC stageNodal metastasis
Hurtuk et al[82]1984-20055235 (67)24NAGrade, positive margins, nodal metastasis, venous or perineural invasionStage T4, tumor size < 3.5 cm-
Hu et al[47]NA4328 (65)1127-Positive margins-
Sarela et al[51]1983-200013772 (52.5)56711Gender, grade, T stageAge, nodal metastasisAge, nodal metastasis
Tocchi et al[13]1980-20004725 (53)923T stage, grade, AJCC stage, lymphovascular invasion, perineural invasion, positive margins, size, age-Nodal metastasis
Ryder et al[83]1957-19984931 (63)2743Nodal metastases, location in duodenum, type of resection, adjuvant chemoradiation-Tumor size, histologic grade, transmural invasion
Kaklamanos et al[43]1978-19986337 (59)2630Age, gender, grade, T stageNodal metastasisNodal metastasis
Bakaeen et al[44]1976-199610168 (67)5054Histologic grade, tumor size, location in duodenum, adjuvant chemoradiationAge, weight loss, T stage, nodal metastasis, AJCC stageWeight loss, positive margins, nodal metastasis, AJCC stage
Sohn et al[35]1984-19965548 (87)3553Nodal metastasis, adjuvant chemoradiation, tumor size, histologic gradePositive margins, segmental resection, tumor in third/fourth portion of duodenum-
Sexe et al[76]1987-19918534 (40)3123AJCC Stage--
Rotman et al[84]1978-19886646 (70)3845Gender, age, weight loss, jaundice, T stage, tumor size, pancreatic invasion nodal metastasis, location of metastatic nodes--
Delcore et al[85]1960-19903528 (80)2160-GI bleeding, symptomatic > 4 mo, nodal metastasis-
Barnes et al[40]1967-19916736 (54)2754Nodal metastasisStage
Lowell et al[42]1970-19911717 (100)845-First/second portion of the duodeum-
Ouriel et al[33]1950-19816519 (29)130-Histologic grade, nodal metastasis-