Ann Surg Treat Res.  2017 Jun;92(6):411-418. 10.4174/astr.2017.92.6.411.

Extended versus peripancreatic lymph node dissection for the treatment of left-sided pancreatic cancer

Affiliations
  • 1Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea.
  • 2Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. jsheo.md@gmail.com

Abstract

PURPOSE
The pathways of lymphatic metastases differ according to the tumor location in pancreatic cancer patients. However, it is unclear whether extended lymph node dissection (LND) is essential for all left-sided pancreatic cancer. The aim of this study is to evaluate the survival outcomes according to the extent of LND and tumor location in patients with left-sided pancreatic cancer.
METHODS
January 2005 to December 2013, we retrospectively identified 107 patients who underwent curative intent surgery for left-sided pancreatic cancer. The left-sided pancreatic cancer was defined as a tumor located in pancreatic body or tail. The extent of LND was divided into 2 groups: extended LND and peripancreatic LND. The extended LND group included celiac and superior mesenteric LNs.
RESULTS
We included 107 patients with left-sided pancreatic cancer; 59 patients with pancreatic body cancer and 48 patients with pancreatic tail cancer. The median follow-up period was 17 months (range, 3-110 months). Fifty patients with pancreatic body cancer and 30 patients with pancreatic tail cancer underwent extended LND. In patients with pancreatic body cancer, extended LND was associated with improved disease-free survival (DFS) (P = 0.010) and overall survival (P = 0.014). However, extended LND was not associated with DFS in patients with pancreatic tail cancer.
CONCLUSION
Extended LND could improve survival in patients with pancreatic body cancer. However, extended LND had no survival benefit for the treatment of pancreatic tail cancer.

Keyword

Pancreas; Neoplasms; Lymph node excision; Survival

MeSH Terms

Disease-Free Survival
Follow-Up Studies
Humans
Lymph Node Excision*
Lymph Nodes*
Lymphatic Metastasis
Pancreas
Pancreatic Neoplasms*
Retrospective Studies
Tail

Figure

  • Fig. 1 Disease free survival (DFS) curves according to the location and number of lymph node (LN) metastasis. Extended group LNs include celiac LNs and superior mesenteric LNs. (A) DFS curves according to the location of LN metastasis. (B) DFS curves according to the number of LN metastasis.

  • Fig. 2 Disease free survival (DFS) and overall survival (OS) curves according to the extent of lymph node dissection (LND) and tumor location (A) DFS curves in patients with pancreatic body cancer, (B) DFS curves in patients with pancreatic tail cancer, (C) OS curves in patients with pancreatic body cancer, (D) OS curves in patients with pancreatic tail cancer.


Reference

1. Strasberg SM, Drebin JA, Linehan D. Radical antegrade modular pancreatosplenectomy. Surgery. 2003; 133:521–527.
2. Strasberg SM, Linehan DC, Hawkins WG. Radical antegrade modular pancreatosplenectomy procedure for adenocarcinoma of the body and tail of the pancreas: ability to obtain negative tangential margins. J Am Coll Surg. 2007; 204:244–249.
3. Chang YR, Han SS, Park SJ, Lee SD, Yoo TS, Kim YK, et al. Surgical outcome of pancreatic cancer using radical antegrade modular pancreatosplenectomy procedure. World J Gastroenterol. 2012; 18:5595–5600.
4. Park HJ, You DD, Choi DW, Heo JS, Choi SH. Role of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of the pancreas. World J Surg. 2014; 38:186–193.
5. Mitchem JB, Hamilton N, Gao F, Hawkins WG, Linehan DC, Strasberg SM. Long-term results of resection of adenocarcinoma of the body and tail of the pancreas using radical antegrade modular pancreatosplenectomy procedure. J Am Coll Surg. 2012; 214:46–52.
6. Latorre M, Ziparo V, Nigri G, Balducci G, Cavallini M, Ramacciato G. Standard retrograde pancreatosplenectomy versus radical antegrade modular pancreatosplenectomy for body and tail pancreatic adenocarcinoma. Am Surg. 2013; 79:1154–1158.
7. Trottman P, Swett K, Shen P, Sirintrapun J. Comparison of standard distal pancreatectomy and splenectomy with radical antegrade modular pancreatosplenectomy. Am Surg. 2014; 80:295–300.
8. Dasari BV, Pasquali S, Vohra RS, Smith AM, Taylor MA, Sutcliffe RP, et al. Extended versus standard lymphadenectomy for pancreatic head cancer: meta-analysis of randomized controlled trials. J Gastrointest Surg. 2015; 19:1725–1732.
9. Jang JY, Kang MJ, Heo JS, Choi SH, Choi DW, Park SJ, et al. A prospective randomized controlled study comparing outcomes of standard resection and extended resection, including dissection of the nerve plexus and various lymph nodes, in patients with pancreatic head cancer. Ann Surg. 2014; 259:656–664.
10. Pedrazzoli S. Extent of lymphadenectomy to associate with pancreaticoduodenectomy in patients with pancreatic head cancer for better tumor staging. Cancer Treat Rev. 2015; 41:577–587.
11. Strasberg SM, Fields R. Left-sided pancreatic cancer: distal pancreatectomy and its variants: radical antegrade modular pancreatosplenectomy and distal pancreatectomy with celiac axis resection. Cancer J. 2012; 18:562–570.
12. Cesmebasi A, Malefant J, Patel SD, Du Plessis M, Renna S, Tubbs RS, et al. The surgical anatomy of the lymphatic system of the pancreas. Clin Anat. 2015; 28:527–537.
13. Seevaratnam R, Bocicariu A, Cardoso R, Mahar A, Kiss A, Helyer L, et al. A meta-analysis of D1 versus D2 lymph node dissection. Gastric Cancer. 2012; 15:Suppl 1. S60–S69.
14. Shimada K, Sakamoto Y, Sano T, Kosuge T. Prognostic factors after distal pancreatectomy with extended lymphadenectomy for invasive pancreatic adenocarcinoma of the body and tail. Surgery. 2006; 139:288–295.
15. Kang MJ, Jang JY, Chang YR, Kwon W, Jung W, Kim SW. Revisiting the concept of lymph node metastases of pancreatic head cancer: number of metastatic lymph nodes and lymph node ratio according to N stage. Ann Surg Oncol. 2014; 21:1545–1551.
16. Pavlidis TE, Pavlidis ET, Sakantamis AK. Current opinion on lymphadenectomy in pancreatic cancer surgery. Hepatobiliary Pancreat Dis Int. 2011; 10:21–25.
17. Liu C, Chen R, Chen Y, Fu D, Hong D, Hao J, et al. Should a standard lymphadenectomy during pancreatoduodenectomy exclude para-aortic lymph nodes for all cases of resectable pancreatic head cancer? A consensus statement by the Chinese Study Group for Pancreatic Cancer (CSPAC). Int J Oncol. 2015; 47:1512–1516.
18. Philips P, Dunki-Jacobs E, Agle SC, Scoggins C, McMasters KM, Martin RC. The role of hepatic artery lymph node in pancreatic adenocarcinoma: prognostic factor or a selection criterion for surgery. HPB (Oxford). 2014; 16:1051–1055.
19. Tol JA, Gouma DJ, Bassi C, Dervenis C, Montorsi M, Adham M, et al. Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery. 2014; 156:591–600.
20. Kang CM, Lee SH, Lee WJ. Minimally invasive radical pancreatectomy for left-sided pancreatic cancer: current status and future perspectives. World J Gastroenterol. 2014; 20:2343–2351.
21. Lee SH, Kang CM, Hwang HK, Choi SH, Lee WJ, Chi HS. Minimally invasive RAMPS in well-selected left-sided pancreatic cancer within Yonsei criteria: long-term (>median 3 years) oncologic outcomes. Surg Endosc. 2014; 28:2848–2855.
22. Oettle H, Neuhaus P, Hochhaus A, Hartmann JT, Gellert K, Ridwelski K, et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA. 2013; 310:1473–1481.
23. Neoptolemos JP, Stocken DD, Bassi C, Ghaneh P, Cunningham D, Goldstein D, et al. Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial. JAMA. 2010; 304:1073–1081.
24. Maeda A, Boku N, Fukutomi A, Kondo S, Kinoshita T, Nagino M, et al. Randomized phase III trial of adjuvant chemotherapy with gemcitabine versus S-1 in patients with resected pancreatic cancer: Japan Adjuvant Study Group of Pancreatic Cancer (JASPAC-01). Jpn J Clin Oncol. 2008; 38:227–229.
Full Text Links
  • ASTR
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr