Treatment and Outcomes for Patients With Inadequate Lymphadenectomy After Resection of Stage II Small Bowel Adenocarcinoma

Abstract

Background and objectives: Adjuvant chemotherapy (AC) is considered for patients with stage II small bowel adenocarcinoma (SBA) with an inadequate lymphadenectomy; however, the prognostic role of additional high-risk features (T4 primary, positive resection margin, poorly differentiated tumor, or lymphovascular invasion) is unknown. The objectives were to describe utilization of AC among patients with stage II SBA with inadequate lymphadenectomy, identify factors associated with receipt of AC, and examine the association between AC and survival stratified by presence of additional high-risk features. Methods: Patients with stage II SBA were identified using the National Cancer Database from 2004 to 2021. Inadequate lymphadenectomy was defined < 5 lymph nodes duodenal tumors and < 8 lymph nodes other sites. Results: Of 1765 patients with stage II SBA and an inadequate lymphadenectomy, 525 (29.8%) received AC. T4 primary, poor grade tumor, and positive resection margin were associated with receiving AC. Receipt of AC was associated with improved 5-year survival in patients with additional high-risk features (49.9% vs 31.4%; HR 0.62, 95%CI 0.48-0.79) but not in patients without additional high-risk features (67.1% vs. 53.2%; HR 0.83, 95%CI 0.55-1.24). Conclusions: Receipt of AC was associated with improved survival in patients with inadequate lymphadenectomy and any additional high-risk feature. Multiple variables may be considered in decisions regarding AC.