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

• Lee H
• Heo JS
• Choi SH
• Choi DW

• KMID: 2387414
• DOI: http://doi.org/10.4174/astr.2017.92.6.411

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.

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