ABSTRACT Background and Objective Endoscopic resection (ER) is increasingly used for early‐stage duodenal adenocarcinoma (DA). This study aimed to identify factors guiding ER selection for clinical T1/T2N0 DA. Methods A retrospective National Cancer Database analysis (2010–2021) included patients with clinical T1/T2N0M0 DA with available pathological staging among those who underwent surgical resection. Outcomes were overall survival and lymph node upstaging (LNU). Survival was evaluated using Cox proportional hazard models, and predictors of LNU were assessed using logistic regression. Results Among 527 patients, 68 underwent ER and 459 underwent a major resection. Overall survival did not differ between the two groups (HR: 0.96, 95% CI: 0.65–1.40). Among major resections, nodal upstaging occurred in about 40% of patients and was associated with worse survival (T1 HR: 1.72, 95% CI: 1.18–2.50) and (T2 HR: 2.06, 95% CI: 1.28–3.33). Poor differentiation (OR: 2.83, 95% CI: 1.08–7.45), lymphovascular invasion (OR 7.19, 95% CI: 4.48–11.53), and age (≥ 80 compared to < 65—OR: 0.40, 95% CI: 0.20–0.82) were significant predictors of LNU. Conclusion Nearly 40% of clinically node‐negative T1/T2 DA patients who underwent a major resection had LNU, which was associated with worse overall survival. Pathologic features should guide ER selection. Synopsis Among clinically node‐negative T1/T2 duodenal adenocarcinomas, 40% of patients who underwent major resections had lymph node upstaging, which was associated with worse survival; lymphovascular invasion, poor differentiation, and older age were significant predictors of nodal upstaging. The importance of these findings underscores the need for duodenal adenocarcinoma‐specific guidelines to guide endoscopic resection in early T‐stage disease.
Morocho et al. (Sun,) studied this question.
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