Clinicopathologic features and prognostic significance of duodenal invasion were studied in a retrospective study on 593 patients who underwent gastrectomy for adenocarcinoma in the antrum. The patients were grouped into three, according to the histologic extent of duodenal invasion: Group A (80 patients), obvious invasion beyond the pyloric ring; Group B (61 patients), invasion up to the pyloric ring; and Group C (452 patients), no evidence of duodenal invasion. Five-year survival rates in Groups A, B, and C were 7.9'10, 31.6%, and 57.6'10, respectively (P < 0.001). Cox's regression analysis showed that duodenal invasion is an independent prognostic factor in cases of a gastric antrum carcinoma. Gastric cancer with duodenal invasion (Groups A and B) most often was infiltrative and the incidence of serosal invasion, lymphatic and vascular invasion, and lymph node metastasis was high. Duodenal invasion was direct through submucosal or subserosal layers or through submucosal lymphatics. Cancer 68:380-384,1991.
HE INCIDENCE of carcinoma in the gastric antrum
T invading the duodenum ranges from 9% to 69%.'-4
Koehler et a/.' noticed that duodenal invasion was detectable radiographically in 5% of all patients with a gastric carcinoma, but that histologically the incidence was 18%. Zinninger and Collins' reported that even in macroscopically well-localized gastric lesions, microscopic extension into the duodenum occurred as far as 35 mm from the apparent edge of the tumor. Thus, duodenal invasion by gastric cancer seems to be more frequent than expected, based on gross appearance of the tumor. The prognosis of patients with a gastric carcinoma invading the duodenum has only infrequently been documented. We describe here the relationship between the extent of duodenal invasion by tumor and the prognosis in 593 patients with adenocarcinoma in the gastric antrum. We also examine From the Department of Surgery 11. Faculty of Medicine, Kyushu
The authors thank M. Ohara for helpful comments.