Clinicopathological features of early gastric cancer with duodenal invasion

Abstract

The incidence of early gastric cancer (EGC) with duodenal invasion is extremely low, although advanced gastric cancer that arises in the antrum occasionally invades the duodenum. We investigated the clinicopathological features of EGC with duodenal invasion and provided strategies for clinical management. A Medline search was performed using the keyword "early gastric cancer" and "duodenal invasion". Additional articles were obtained from references within the papers identified by the Medline search. We revealed that EGC with duodenal invasion was of the superficial spreading type of tumor. Tumors > 60 mm in size invaded the duodenum more extensively, and the distance of duodenal invasion from the pyloric ring was further in the elevated type than in the depressed type of tumor. There was no significant difference between the length of duodenal invasion and the histological type of the tumor. Gastric cancer located adjacent to the pyloric ring, even if cancer invasion was confined to the mucosa or submucosa, was more likely to invade the duodenum. The present study reveals that the elevated type of EGC is associated with more extensive duodenal invasion when the tumor size is > 60 mm, thus highlighting the importance of identification of duodenal invasion in these cases. We also reveal that sufficient duodenal resection with a cancer-free distal surgical margin should be performed in cases of duodenal invasion.

Clinicopathological Properties of the Superficial Spreading Type Early Gastric Cancer

“…20 In addition, we have previously reported that the superficial spreading type of EGC adjacent to the pyloric ring correlates positively with a more extensive duodenal invasion. 21 Furthermore, Kunisaki et al reported that the number of metastatic lymph nodes was greater in the superficial spreading type of EGC than in the common tumor type. 10 Recurrence of EGC was shown to be significantly higher in the patient group with submucosal, node-positive, and undifferentiated tumors.…”

Delayed duodenal stump blow-out following total gastrectomy for cancer: Heightened awareness for the continued presence of the surgical past in the present is the key to a successful duodenal stump disruption management. A case report

“…Despite the fact that the number of gastric cancer encounters with a difficult ultra-low DS is relatively low, upper gastrointestinal surgeons will still encounter this surgical challenge. 5 Therefore, in such circumstances familiarity with alternative surgical methods such as Nissen closure, end or side tube-duodenostomy and Roux-en-Y end-to-end duodenojejunal anastomosis can provide the ability to successfully overcome the challenging surgical obstacle of the “difficult” DS. 6 While effective however, all these techniques have certain drawbacks and limitations when indented to be applied to a given surgical scenario.…”

Early Rupture of an Ultralow Duodenal Stump after Extended Surgery for Gastric Cancer with Duodenal Invasion Managed by Tube Duodenostomy and Cholangiostomy

“…Gastric cancer with duodenal invasion has been reported with an incidence of 15–40% [6]. Kakeji et al analyzed 95 patients with duodenal invasion by gastric cancer and found that tumor spread into the duodenum was limited to within 2 cm in 76% of the patients and to within 3 cm in 81% of the patients.…”