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Chen R, Xiao C, Song S, Zhu L, Zhang T, Liu R. The optimal choice for patients underwent minimally invasive pancreaticoduodenectomy: a systematic review and meta-analysis including patient subgroups. Surg Endosc 2024; 38:6237-6253. [PMID: 39322827 DOI: 10.1007/s00464-024-11289-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 09/13/2024] [Indexed: 09/27/2024]
Abstract
The aim of this meta-analysis was to evaluate the efficacy and safety of robotic pancreaticoduodenectomy (RPD) in improving perioperative aspects and postoperative complications in patients. METHODS We searched PubMed, Embase, Web of Science, and the Cochrane Library database systems for studies that compared RPD with laparoscopic pancreaticoduodenectomy (LPD). Meta-analysis was performed for 24 relevant outcomes, including perioperative outcomes and postoperative complications. Subsequently, a subgroup analysis based on geographical regions was conducted to investigate the impact of regional differences on the perioperative outcomes of the RPD group and the LPD group. RESULTS This review found 19 studies with 12,731 individuals (3539 RPD and 9192 LPD). In comparison to LPD, RPD had lower rates of Conversion (OR = 0.58, P < 0.00001), Blood Transfusion (OR = 0.59, P = 0.02), Length of Stay (MD = - 0.54, P = 0.01), postoperative complications [Pneumonia (OR = 0.31, P < 0.0001), and Wound Disruption (OR = 0.26, P = 0.0007)], and more thorough lymph node harvesting (MD = 1.25, P = 0.001). Subgroup analysis showed that Blood Transfusion (I2 = 55%, P = 0.02), Conversion (I2 = 30%, P < 0.00001), Length of Stay (I2 = 71%, P = 0.01), and Lymph Node Harvested (I2 = 87%, P = 0.001) were statistically significant. Interestingly, compared to China, other countries had lower rates of Conversion and more lymph nodes harvested for RPD surgery. CONCLUSION The benefits of RPD surgery over LPD surgery in terms of therapy and an optimistic short-term prognosis are clearly supported by this study. Moreover, subgroup analysis based on regional differences revealed statistically significant results for Conversion, Length of Stay (days), Number of Lymph Nodes Harvested and the rate of Blood Transfusion, indicating significant variability across regions. This study provides a solid theoretical foundation and basis for the advancement of RPD in clinical practice.
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Affiliation(s)
- Ruiqiu Chen
- The First School of Clinical Medicine, Lanzhou University, No. 1, Donggangxi Rd, Chengguan District, Lanzhou, 730000, Gansu, China
- Department of Hepato-Biliary-Pancreatic Surgery, the First Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Key Laboratory of Digital Hepatobiliary Surgery PLA, Beijing, China
- Institute of Hepatobiliary Surgery of Chinese PLA, Beiing, China
| | - Chaohui Xiao
- Department of Hepato-Biliary-Pancreatic Surgery, the First Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Key Laboratory of Digital Hepatobiliary Surgery PLA, Beijing, China
- Institute of Hepatobiliary Surgery of Chinese PLA, Beiing, China
| | - Shaoming Song
- The First School of Clinical Medicine, Lanzhou University, No. 1, Donggangxi Rd, Chengguan District, Lanzhou, 730000, Gansu, China
- Department of Hepato-Biliary-Pancreatic Surgery, the First Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Key Laboratory of Digital Hepatobiliary Surgery PLA, Beijing, China
- Institute of Hepatobiliary Surgery of Chinese PLA, Beiing, China
| | - Lin Zhu
- The First School of Clinical Medicine, Lanzhou University, No. 1, Donggangxi Rd, Chengguan District, Lanzhou, 730000, Gansu, China
- Department of Hepato-Biliary-Pancreatic Surgery, the First Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Key Laboratory of Digital Hepatobiliary Surgery PLA, Beijing, China
- Institute of Hepatobiliary Surgery of Chinese PLA, Beiing, China
| | - Tianchen Zhang
- The First School of Clinical Medicine, Lanzhou University, No. 1, Donggangxi Rd, Chengguan District, Lanzhou, 730000, Gansu, China
- Department of Hepato-Biliary-Pancreatic Surgery, the First Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Key Laboratory of Digital Hepatobiliary Surgery PLA, Beijing, China
- Institute of Hepatobiliary Surgery of Chinese PLA, Beiing, China
| | - Rong Liu
- The First School of Clinical Medicine, Lanzhou University, No. 1, Donggangxi Rd, Chengguan District, Lanzhou, 730000, Gansu, China.
- Department of Hepato-Biliary-Pancreatic Surgery, the First Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
- Key Laboratory of Digital Hepatobiliary Surgery PLA, Beijing, China.
- Institute of Hepatobiliary Surgery of Chinese PLA, Beiing, China.
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Seufferlein T, Mayerle J, Boeck S, Brunner T, Ettrich TJ, Grenacher L, Gress TM, Hackert T, Heinemann V, Kestler A, Sinn M, Tannapfel A, Wedding U, Uhl W. S3-Leitlinie Exokrines Pankreaskarzinom – Version 3.1. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:1724-1785. [PMID: 39389105 DOI: 10.1055/a-2338-3716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
Affiliation(s)
| | | | | | - Thomas Brunner
- Universitätsklinik für Strahlentherapie-Radioonkologie, Medizinische Universität Graz, Austria
| | | | | | - Thomas Mathias Gress
- Gastroenterologie und Endokrinologie Universitätsklinikum Gießen und Marburg, Germany
| | - Thilo Hackert
- Klinik und Poliklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf, Germany
| | - Volker Heinemann
- Medizinische Klinik und Poliklinik III, Klinikum der Universität München-Campus Grosshadern, München, Germany
| | | | - Marianne Sinn
- Medizinische Klinik und Poliklinik II Onkologie und Hämatologie, Universitätsklinikum Hamburg-Eppendorf, Germany
| | | | | | - Waldemar Uhl
- Allgemein- und Viszeralchirurgie, St Josef-Hospital, Bochum, Germany
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Seufferlein T, Mayerle J, Boeck S, Brunner T, Ettrich TJ, Grenacher L, Gress TM, Hackert T, Heinemann V, Kestler A, Sinn M, Tannapfel A, Wedding U, Uhl W. S3-Leitlinie Exokrines Pankreaskarzinom – Version 3.1. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:874-995. [PMID: 39389103 DOI: 10.1055/a-2338-3533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
Affiliation(s)
| | | | | | - Thomas Brunner
- Universitätsklinik für Strahlentherapie-Radioonkologie, Medizinische Universität Graz, Austria
| | | | | | - Thomas Mathias Gress
- Gastroenterologie und Endokrinologie Universitätsklinikum Gießen und Marburg, Germany
| | - Thilo Hackert
- Klinik und Poliklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Universitätsklinikum Hamburg-Eppendorf, Germany
| | - Volker Heinemann
- Medizinische Klinik und Poliklinik III, Klinikum der Universität München-Campus Grosshadern, München, Germany
| | | | - Marianne Sinn
- Medizinische Klinik und Poliklinik II Onkologie und Hämatologie, Universitätsklinikum Hamburg-Eppendorf, Germany
| | | | | | - Waldemar Uhl
- Allgemein- und Viszeralchirurgie, St Josef-Hospital, Bochum, Germany
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Yang J, Zhang J, Tan M, Gu J, Tang L, Zheng Y, Zhou Q, Wang X, Xia R, Zhang T, Yang Y, Guo S, Wang H. Identifying suitable candidates for pancreaticoduodenectomy with extended lymphadenectomy for pancreatic ductal adenocarcinoma. HPB (Oxford) 2024; 26:1291-1301. [PMID: 39054211 DOI: 10.1016/j.hpb.2024.07.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 04/24/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND To evaluate long-term quality of life and survival in pancreatic ductal adenocarcinoma (PDAC) patients after pancreatoduodenectomy with extended lymphadenectomy (PDEL) and identify candidates. METHODS Patients with resectable PDAC with ≥1 examined lymph node (LN) during pancreatoduodenectomy (PD), and were divided into the PD with standard lymphadenectomy (PDSL) and PDEL groups. Perioperative data, long-term quality of life and survival were compared, and the prognostic effect of LNs ± in every peripancreatic station were analysed. RESULTS Screening 446 PDAC patients, 237 and 126 were included in the PDSL and PDEL groups, respectively. The PDEL group showed a longer operation time, greater intraoperative blood loss, severe diarrhoea, a higher incidence of grade III complications. Notably, the PDEL patients experienced significant relief from low back pain and diarrhoea, with an obvious survival advantage (p = 0.037), especially in patients with preoperative tumor contact with vascular and pathological N0; however, LNs+ in any station (No. 8p, 12, 14, or 16) were associated with a poorer prognosis. The vascular reconstruction, T and N stage were independent risk factors for survival. CONCLUSION PDEL can relieve symptoms and prolong the survival of PDAC patients with acceptable complications, and EL should be performed regardless of preoperative LN enlargement.
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Affiliation(s)
- Jiali Yang
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing University, Chongqing, China
| | - Junfeng Zhang
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing University, Chongqing, China
| | - Mingda Tan
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing University, Chongqing, China
| | - Jianyou Gu
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing University, Chongqing, China
| | - Li Tang
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing University, Chongqing, China
| | - Yao Zheng
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing University, Chongqing, China
| | - Qiang Zhou
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing University, Chongqing, China
| | - Xianxing Wang
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing University, Chongqing, China
| | - Renpei Xia
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing University, Chongqing, China
| | - Tao Zhang
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing University, Chongqing, China
| | - Yongjun Yang
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing University, Chongqing, China
| | - Shixiang Guo
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing University, Chongqing, China.
| | - Huaizhi Wang
- Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, Chongqing University, Chongqing, China.
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Margonis GA, Pulvirenti A, Morales-Oyarvide V, Buettner S, Andreatos N, Kamphues C, Beyer K, Wang J, Kreis ME, Cameron JL, Weiss MJ, Soares K, Fernández-Del Castillo C, Allen PJ, Wolfgang CL. Performance of the 7 th and 8 th Editions of the American Joint Committee on Cancer Staging System in Patients with Intraductal Papillary Mucinous Neoplasm-Associated PDAC : A Multi-institutional Analysis. Ann Surg 2023; 277:681-688. [PMID: 34793353 DOI: 10.1097/sla.0000000000005313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To validate the 7 th and 8 th editions of the AJCC staging system for patients with invasive carcinomas arising in association with IPMN (IPMN-associated PDAC). BACKGROUND DATA Although several studies have validated AJCC systems in patients with conventional PDAC, their applicability to IPMN-associated PDAC has not been assessed. METHODS Two hundred seventy-five patients who underwent resection for IPMN-associated PDAC between 1996 and 2015 at 3 tertiary centers and had data on the size of the invasive component and lymph node status were identified. Concordance probability estimates (CPE) were calculated and recursive partitioning analysis was employed to identify optimal prognostic cutoffs for T and N. RESULTS The CPE for the 7 th and 8 th editions of the AJCC schema were relatively good (0.64 for both) and similar for colloid and tubular subtypes (0.64 for both). The 8 th edition introduced T1a sub-staging and a new distinction between N1 and N2. The utility of the former was confirmed, although the latter did not improve prognostic discrimination. The successful validation of the 8th edition of the AJCC criteria in patients with tubular and colloid subtypes allowed us to compare these patients in early vs late T and N stages which showed that with advanced disease, the prognostic superiority of colloid tumors over their tubular counterparts diminishes. CONCLUSIONS Our findings support the use of the AJCC 8 th edition in the IPMN-associated PDAC population, but suggest that certain cutoffs may need to be revisited. In advanced AJCC stages, patients with colloid vs tubular subtypes have comparable prognosis.
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Affiliation(s)
- Georgios Antonios Margonis
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of General and Visceral Surgery, Charite Campus Benjamin Franklin, Berlin, Germany
| | | | | | - Stefan Buettner
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | | | - Carsten Kamphues
- Department of General and Visceral Surgery, Charite Campus Benjamin Franklin, Berlin, Germany
| | - Katharina Beyer
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Jane Wang
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Martin E Kreis
- Department of General and Visceral Surgery, Charite Campus Benjamin Franklin, Berlin, Germany
| | - John L Cameron
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Matthew J Weiss
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Kevin Soares
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Peter J Allen
- Department of Surgery, Hepatopancreatobiliary Service, Duke, University School of Medicine, Durham, NC
| | - Christopher L Wolfgang
- Department of Surgery, Division of Hepatobiliary Surgery, New York University Langone, New York, NY
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Surgical treatment of pancreatic cancer: Currently debated topics on morbidity, mortality, and lymphadenectomy. Surg Oncol 2022; 45:101858. [DOI: 10.1016/j.suronc.2022.101858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/07/2022] [Accepted: 09/26/2022] [Indexed: 11/21/2022]
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Arslan B, Kose E, Tazeoğlu D, Karahan SR. The Effect of Increase in Clinical Experience on Morbidity and Mortality After Pancreaticoduodenectomy Surgery. POLISH JOURNAL OF SURGERY 2021; 94:8-16. [DOI: 10.5604/01.3001.0015.5993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
<b> Introduction:</b> Pancreaticoduodenectomy surgery is widely accepted and applied worldwide for periampullary tumors. Despite the decline in mortality rates from 40% to 3% with the advances in surgical technique, morbidity is still high (40–50%). </br></br> <b>Aim:</b> We aimed to investigate the effect of increased clinical experience on the length of hospital stay, morbidity, mortality, and survival after pancreaticoduodenectomy. </br></br> <b> Materials and methods:</b> The files of patients who underwent pancreaticoduodenectomy in our hospital between January 2007 and January 2018 were retrospectively reviewed and divided into four groups by years. Demographics, body mass index (BMI, kg/m2), medical history, preoperative biliary drainage application, surgical technique, histopathological features, postoperative morbidity, mortality, and survival were investigated. </br></br> <b> Results: </b> There was no difference between the groups in terms of age, gender, comorbid disease, history of biliary drainage, surgical technique, and operation time (P > 0.05). The rate of postoperative complications has decreased over the years (P = 0.01). According to the Clavien-Dindo scale, the complication severity decreased significantly over the years (P = 0.05). The overall survival of the patients increased by years (P = 0.03); the Early postoperative mortality rate decreased in the first month (<30 days) (P = 0.04). </br></br> <b> Conclusion:</b> With increased clinical experience, morbidity and mortality decrease, overall survival is prolonged after pancreaticoduodenectomy procedure.
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Affiliation(s)
- Bilal Arslan
- Department of Surgery, Division of Surgical Oncology, Mersin University, Turkey
| | - Emin Kose
- Department of Surgery, Prof. Dr. Cemil Taşçıoğlu City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Deniz Tazeoğlu
- Department of Surgery, Division of Surgical Oncology, Mersin University, Turkey
| | - Servet Rüştü Karahan
- Department of Surgery, Prof. Dr. Cemil Taşçıoğlu City Hospital, University of Health Sciences, Istanbul, Turkey
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[Definition and treatment of superior mesenteric artery revascularization and dissection-associated diarrhea (SMARD syndrome) in Germany]. Chirurg 2021; 93:173-181. [PMID: 34100984 PMCID: PMC8821061 DOI: 10.1007/s00104-021-01427-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 11/28/2022]
Abstract
Hintergrund Die A. mesenterica superior (AMS) wird im Rahmen von Pankreasresektionen (PR) und mesenterialen Gefäßeingriffen (MG) freigelegt und disseziert. Eine dadurch entstandene Schädigung des umliegenden ex- und intrinsischen vegetativen Nervenplexus kann zu einer passageren oder therapierefraktären Diarrhö führen. Fragestellung Die vorliegende Studie soll einen Überblick über den derzeitigen Stellenwert der AMS-Revaskularisations- und -Dissektions-assoziierten Diarrhö („superior mesenteric artery revascularisation and dissection-associated diarrhea“[SMARD]-Syndrom) in Deutschland geben. Material und Methoden Nach selektiver Literaturrecherche (SLR) mit der Fragestellung, ob und wie häufig eine postoperativ neu aufgetretene Diarrhö nach PR und MG vorkommt, wurde eine Onlineumfrage versendet. Ergebnisse Die SLR (n = 4) bestätigte, dass eine postoperativ neu aufgetretene Diarrhö eine häufige Komplikation nach Präparation zur Revaskularisation (RV) bzw. Dissektion (DIS) der AMS ist (Inzidenz ca. 62 %). Therapierefraktäre Verläufe sind selten 14 %. 54 von 159 Zentren beteiligten sich an der Umfrage. 63 % gaben an, eine AMS-RV/-DIS im Rahmen von PR oder MG durchzuführen. Der Durchschnitt an PR pro Zentrum lag 2018 bei 47 und bei 49 im Jahr 2019. Fünf MG erfolgten durchschnittlich in beiden Jahren pro Zentrum. Drei Patienten litten durchschnittlich am SMARD-Syndrom. Diskussion Diese Umfrage erfasst erstmals den derzeitigen Stellenwert des SMARD-Syndroms in Deutschland. Bisher fehlen Empfehlungen zur Therapie einer solchen Diarrhö. Die Ergebnisse zeigen, dass zunächst eine symptomatische Therapie erfolgen sollte. Aufgrund der Komplexität der Pathophysiologie sind kausale Therapieansätze bislang nicht entwickelt.
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Hu Q, Sun Y, Chen J. Comment on "Early postoperative outcomes among patients with delayed surgeries after preoperative positive test for SARS-CoV-2: A case-control study from a single institution". J Surg Oncol 2021; 123:1642-1644. [PMID: 33751573 PMCID: PMC8250813 DOI: 10.1002/jso.26414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 01/25/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Qiang Hu
- Department of General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Yuanshui Sun
- Department of General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Jian Chen
- Department of General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, China
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Tseng DSJ, Pranger BK, van Leeuwen MS, Pennings JP, Brosens LA, Mohammad NH, de Meijer VE, van Santvoort HC, Erdmann JI, Molenaar IQ. The Role of CT in Assessment of Extraregional Lymph Node Involvement in Pancreatic and Periampullary Cancer: A Diagnostic Accuracy Study. Radiol Imaging Cancer 2021; 3:e200014. [PMID: 33817647 DOI: 10.1148/rycan.2021200014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 10/15/2020] [Accepted: 11/18/2020] [Indexed: 01/06/2023]
Abstract
Purpose To investigate the diagnostic accuracy of CT in assessing extraregional lymph node metastases in pancreatic head and periampullary cancer. Materials and Methods This prospective observational cohort study was performed at two tertiary hepatopancreatobiliary (HPB) referral centers between March 2013 and December 2014. Patients undergoing pancreatoduodenectomy or bypass surgery with or without palliative radiofrequency ablation were included. Extraregional lymph node involvement was defined as positive lymph nodes in the aortocaval window. Two expert HPB radiologists assessed aortocaval lymph nodes at preoperative CT according to a standardized protocol. All tissue from the aortocaval window was collected intraoperatively. Positive histopathologic finding was the reference standard. Analysis of predictive values and diagnostic accuracy was performed. Results A total of 198 consecutive patients (mean age, 66 years; range, 39-86 years; 105 men) with pancreatic head or periampullary carcinoma were included. In 70% of patients, a pancreatoduodenectomy was performed, 4% underwent total pancreatectomy, 4% underwent radiofrequency ablation, and 22% underwent bypass surgery. Forty-four patients (22%) had histologically positive aortocaval lymph nodes. Negative predictive value of CT in assessing aortocaval lymph nodes was 80% for both observers, and positive predictive value was 31%-33%. Overall diagnostic accuracy was 69%-70%. Conclusion CT has a low diagnostic accuracy in assessing extraregional lymph node metastases in patients suspected of having pancreatic or periampullary cancer.Keywords: CT, Abdomen/GI, Pancreas, Oncology© RSNA, 2021.
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Affiliation(s)
- Dorine S J Tseng
- Department of Surgery, University Medical Center Utrecht and St Antonius Hospital Nieuwegein, Regional Academic Cancer Center Utrecht, Heidelberglaan 100, HG G04.228, PO Box 85500, 3508 GA, Utrecht, the Netherlands (D.S.J.T., H.C.v.S., I.Q.M.); University of Groningen and University Medical Center Groningen, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Groningen, the Netherlands (B.K.P., V.E.d.M., J.I.E.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (M.S.v.L.); University of Groningen and University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands (J.P.P.); Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands (L.A.B.); Department of Medical Oncology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (N.H.M.)
| | - Bobby K Pranger
- Department of Surgery, University Medical Center Utrecht and St Antonius Hospital Nieuwegein, Regional Academic Cancer Center Utrecht, Heidelberglaan 100, HG G04.228, PO Box 85500, 3508 GA, Utrecht, the Netherlands (D.S.J.T., H.C.v.S., I.Q.M.); University of Groningen and University Medical Center Groningen, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Groningen, the Netherlands (B.K.P., V.E.d.M., J.I.E.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (M.S.v.L.); University of Groningen and University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands (J.P.P.); Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands (L.A.B.); Department of Medical Oncology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (N.H.M.)
| | - Maarten S van Leeuwen
- Department of Surgery, University Medical Center Utrecht and St Antonius Hospital Nieuwegein, Regional Academic Cancer Center Utrecht, Heidelberglaan 100, HG G04.228, PO Box 85500, 3508 GA, Utrecht, the Netherlands (D.S.J.T., H.C.v.S., I.Q.M.); University of Groningen and University Medical Center Groningen, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Groningen, the Netherlands (B.K.P., V.E.d.M., J.I.E.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (M.S.v.L.); University of Groningen and University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands (J.P.P.); Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands (L.A.B.); Department of Medical Oncology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (N.H.M.)
| | - Jan Pieter Pennings
- Department of Surgery, University Medical Center Utrecht and St Antonius Hospital Nieuwegein, Regional Academic Cancer Center Utrecht, Heidelberglaan 100, HG G04.228, PO Box 85500, 3508 GA, Utrecht, the Netherlands (D.S.J.T., H.C.v.S., I.Q.M.); University of Groningen and University Medical Center Groningen, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Groningen, the Netherlands (B.K.P., V.E.d.M., J.I.E.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (M.S.v.L.); University of Groningen and University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands (J.P.P.); Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands (L.A.B.); Department of Medical Oncology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (N.H.M.)
| | - Lodewijk A Brosens
- Department of Surgery, University Medical Center Utrecht and St Antonius Hospital Nieuwegein, Regional Academic Cancer Center Utrecht, Heidelberglaan 100, HG G04.228, PO Box 85500, 3508 GA, Utrecht, the Netherlands (D.S.J.T., H.C.v.S., I.Q.M.); University of Groningen and University Medical Center Groningen, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Groningen, the Netherlands (B.K.P., V.E.d.M., J.I.E.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (M.S.v.L.); University of Groningen and University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands (J.P.P.); Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands (L.A.B.); Department of Medical Oncology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (N.H.M.)
| | - Nadja Haj Mohammad
- Department of Surgery, University Medical Center Utrecht and St Antonius Hospital Nieuwegein, Regional Academic Cancer Center Utrecht, Heidelberglaan 100, HG G04.228, PO Box 85500, 3508 GA, Utrecht, the Netherlands (D.S.J.T., H.C.v.S., I.Q.M.); University of Groningen and University Medical Center Groningen, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Groningen, the Netherlands (B.K.P., V.E.d.M., J.I.E.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (M.S.v.L.); University of Groningen and University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands (J.P.P.); Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands (L.A.B.); Department of Medical Oncology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (N.H.M.)
| | - Vincent E de Meijer
- Department of Surgery, University Medical Center Utrecht and St Antonius Hospital Nieuwegein, Regional Academic Cancer Center Utrecht, Heidelberglaan 100, HG G04.228, PO Box 85500, 3508 GA, Utrecht, the Netherlands (D.S.J.T., H.C.v.S., I.Q.M.); University of Groningen and University Medical Center Groningen, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Groningen, the Netherlands (B.K.P., V.E.d.M., J.I.E.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (M.S.v.L.); University of Groningen and University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands (J.P.P.); Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands (L.A.B.); Department of Medical Oncology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (N.H.M.)
| | - Hjalmar C van Santvoort
- Department of Surgery, University Medical Center Utrecht and St Antonius Hospital Nieuwegein, Regional Academic Cancer Center Utrecht, Heidelberglaan 100, HG G04.228, PO Box 85500, 3508 GA, Utrecht, the Netherlands (D.S.J.T., H.C.v.S., I.Q.M.); University of Groningen and University Medical Center Groningen, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Groningen, the Netherlands (B.K.P., V.E.d.M., J.I.E.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (M.S.v.L.); University of Groningen and University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands (J.P.P.); Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands (L.A.B.); Department of Medical Oncology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (N.H.M.)
| | - Joris I Erdmann
- Department of Surgery, University Medical Center Utrecht and St Antonius Hospital Nieuwegein, Regional Academic Cancer Center Utrecht, Heidelberglaan 100, HG G04.228, PO Box 85500, 3508 GA, Utrecht, the Netherlands (D.S.J.T., H.C.v.S., I.Q.M.); University of Groningen and University Medical Center Groningen, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Groningen, the Netherlands (B.K.P., V.E.d.M., J.I.E.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (M.S.v.L.); University of Groningen and University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands (J.P.P.); Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands (L.A.B.); Department of Medical Oncology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (N.H.M.)
| | - I Quintus Molenaar
- Department of Surgery, University Medical Center Utrecht and St Antonius Hospital Nieuwegein, Regional Academic Cancer Center Utrecht, Heidelberglaan 100, HG G04.228, PO Box 85500, 3508 GA, Utrecht, the Netherlands (D.S.J.T., H.C.v.S., I.Q.M.); University of Groningen and University Medical Center Groningen, Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Groningen, the Netherlands (B.K.P., V.E.d.M., J.I.E.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (M.S.v.L.); University of Groningen and University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands (J.P.P.); Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands (L.A.B.); Department of Medical Oncology, Regional Academic Cancer Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (N.H.M.)
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11
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Tsiotos GG, Ballian N, Michelakos T, Milas F, Ziogou P, Papaioannou D, Salla C, Athanasiadis I, Razis E, Stavridi F, Psomas M. Portal-Mesenteric Vein Resection in Borderline Pancreatic Cancer; 33 Month-Survival in Patients with Good Performance Status. J Pancreat Cancer 2019; 5:43-50. [PMID: 31559380 PMCID: PMC6761582 DOI: 10.1089/pancan.2019.0013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Patients with pancreatic cancer (PC), which is not upfront resectable, but borderline, involving major peripancreatic vessels, have not been generally considered for surgery, considering that resection in such a setting may be futile. Materials and Methods: Retrospective analysis of prospectively collected data on patients with borderline pancreatic adenocarcinoma undergoing pancreatectomy en-block with portal and/or superior mesenteric vein resection in a tertiary referral center in Greece between January 2012 and February 2017. Follow-up was complete up to January 2018. Results: Twenty-four patients were included. Neoadjuvant therapy (NAT) was administered to only 38%, but more commonly in the second half of the group (58% vs. 17%, p = 0.035). It was associated with smaller tumor size (median: 2.5 vs. 4.2 cm, p < 0.001), fewer positive lymph nodes (LNs) in the resected specimen (median: 2 vs. 5, p = 0.04), and higher likelihood of adjuvant therapy (78% vs. 40%, p = 0.01), but not with survival. Resection was extensive: a median of 26 LNs were retrieved, R0 resection rate (≥1 mm) was 79%, and median length of vein segments was 4 cm, requiring interposition grafts in 58% (mostly polytetrafluoroethylene). Median intensive care unit stay was 0 days and length of hospital stay was 9 days. Post-operative mortality was 12.5%. Median overall survival was 24 months. Eastern Cooperative Oncology Group (ECOG) status was significantly associated with survival (p < 0.001) with ECOG-0: 33 months, ECOG-1: 12 months, and ECOG-2: 6 months. Conclusion: This first Greek national series of portomesenteric vein resection in borderline PC demonstrates that it results to 2 years of median survival, extending to 33 months in patients with good performance status, especially if NAT is uniformly administered.
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Affiliation(s)
| | | | | | - Fotios Milas
- Department of Surgery, Mitera-Hygeia Hospitals, Marousi, Greece
| | - Panoraia Ziogou
- Department of Surgery, Mitera-Hygeia Hospitals, Marousi, Greece
| | | | - Charitini Salla
- Department of Cytology, Mitera-Hygeia Hospitals, Marousi, Greece
| | - Ilias Athanasiadis
- Department of Medical Oncology, Mitera-Hygeia Hospitals, Marousi, Greece
| | - Evangelia Razis
- Department of Medical Oncology, Mitera-Hygeia Hospitals, Marousi, Greece
| | - Flora Stavridi
- Department of Medical Oncology, Mitera-Hygeia Hospitals, Marousi, Greece
| | - Maria Psomas
- Department of Anesthesiology, Mitera-Hygeia Hospitals, Marousi, Greece
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12
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Lambert A, Schwarz L, Borbath I, Henry A, Van Laethem JL, Malka D, Ducreux M, Conroy T. An update on treatment options for pancreatic adenocarcinoma. Ther Adv Med Oncol 2019; 11:1758835919875568. [PMID: 31598142 PMCID: PMC6763942 DOI: 10.1177/1758835919875568] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 08/19/2019] [Indexed: 12/24/2022] Open
Abstract
Pancreatic cancer is one of the most lethal solid organ tumors. Due to the rising incidence, late diagnosis, and limited treatment options, it is expected to be the second leading cause of cancer deaths in high income countries in the next decade. The multidisciplinary treatment of this disease depends on the stage of cancer at diagnosis (resectable, borderline, locally advanced, and metastatic disease), and combines surgery, chemotherapy, chemoradiotherapy, and supportive care. The landscape of multidisciplinary pancreatic cancer treatment is changing rapidly, especially in locally advanced disease, and the number of treatment options in metastatic disease, including personalized medicine, innovative targets, immunotherapy, therapeutic vaccines, adoptive T-cell transfer, or stemness inhibitors, will probably expand in the near future. This review summarizes the current literature and provides an overview of how new therapies or new therapeutic strategies (neoadjuvant therapies, conversion surgery) will guide multidisciplinary disease management, future clinical trials, and, hopefully, will increase overall survival.
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Affiliation(s)
- Aurélien Lambert
- Department of Medical Oncology, Institut de Cancérologie de Lorraine and Université de Lorraine, Nancy, France
| | - Lilian Schwarz
- Department of Digestive Surgery, Rouen University Hospital and Université de Rouen Normandie, France
| | - Ivan Borbath
- Department of Gastroenterology and Digestive Oncology, Cliniques Universitaires Saint-Luc and Université Catholique de Louvain, Brussels, Belgium
| | - Aline Henry
- Department of Supportive Care in Oncology, Institut de Cancérologie de Lorraine, Nancy, France
| | - Jean-Luc Van Laethem
- Department of Gastroenterology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Belgium
| | - David Malka
- Department of Medical Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Michel Ducreux
- Department of Medical Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Thierry Conroy
- Institut de Cancérologie de Lorraine, 6 avenue de Bourgogne, 50519 Vandoeuvre-lès-Nancy CEDEX, France
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13
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Hua J, Zhang B, Xu J, Liu J, Ni Q, He J, Zheng L, Yu X, Shi S. Determining the optimal number of examined lymph nodes for accurate staging of pancreatic cancer: An analysis using the nodal staging score model. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2019; 45:1069-1076. [PMID: 30685327 DOI: 10.1016/j.ejso.2019.01.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 01/11/2019] [Accepted: 01/16/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The aim of this study was to determine the optimal number of examined lymph nodes (ELNs) for accurate staging of pancreatic cancer using the nodal staging score model. MATERIALS AND METHODS Clinicopathological data for patients with resected pancreatic cancer were collected from SEER database (development cohort [DC]) and Fudan University Shanghai Cancer Center database (validation cohort [VC]). Multivariable models were constructed to assess how the number of ELNs was associated with stage migration and overall survival (OS). Using the β-binomial distribution, we developed a nodal staging score model from the DC and tested it with the VC. RESULTS Both cohorts exhibited significant proportional increases from node-negative to node-positive disease (DC: odds ratio [OR], 1.047; P < 0.001; VC: OR, 1.035; P < 0.001) and improved OS (DC: hazard ratio [HR], 0.982; P < 0.001; VC: HR, 0.979; P < 0.001) as ELNs increased. Nodal staging scores escalated separately as ELNs increased for different tumor (T) stages, with plateaus at 16, 21, and 23 LNs (cut-offs) for T1, T2, and T3 tumors, respectively. Multivariable analysis indicated that examining more LNs than the corresponding cut-off value was a significant survival predictor (DC: HR, 0.813; P < 0.001; VC: HR, 0.696; P = 0.028). CONCLUSION The optimal number of ELNs for adequate staging of pancreatic cancer was related to T stage. We recommend examining at least 16, 21, and 23 LNs for T1, T2, and T3 tumors, respectively, as a nodal staging quality measure for both surgery and pathological analysis.
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Affiliation(s)
- Jie Hua
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China; Shanghai Pancreatic Cancer Institute, Shanghai, China
| | - Bo Zhang
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China; Shanghai Pancreatic Cancer Institute, Shanghai, China
| | - Jin Xu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China; Shanghai Pancreatic Cancer Institute, Shanghai, China
| | - Jiang Liu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China; Shanghai Pancreatic Cancer Institute, Shanghai, China
| | - Quanxing Ni
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China; Shanghai Pancreatic Cancer Institute, Shanghai, China
| | - Jin He
- Department of Surgery, The Pancreatic Cancer Precision Medicine Center of Excellence Program, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lei Zheng
- Department of Surgery, The Pancreatic Cancer Precision Medicine Center of Excellence Program, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Oncology, The Pancreatic Cancer Precision Medicine Center of Excellence Program, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xianjun Yu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China; Shanghai Pancreatic Cancer Institute, Shanghai, China.
| | - Si Shi
- Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China; Shanghai Pancreatic Cancer Institute, Shanghai, China.
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14
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Maplanka C. A comprehensive study of the mesopancreas as an extension of the pancreatic circumferential resection margin. Eur Surg 2018. [DOI: 10.1007/s10353-018-0535-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Masuda T, Dann AM, Elliott IA, Baba H, Kim S, Sedarat A, Muthusamy VR, Girgis MD, Joe Hines O, Reber HA, Donahue TR. A Comprehensive Assessment of Accurate Lymph Node Staging and Preoperative Detection in Resected Pancreatic Cancer. J Gastrointest Surg 2018; 22:295-302. [PMID: 29043580 DOI: 10.1007/s11605-017-3607-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/28/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND The current (seventh edition) American Joint Commission on Cancer (AJCC) Staging System for pancreatic ductal adenocarcinoma (PDAC) dichotomizes pathologic lymph node (LN) involvement into absence (pN0) or presence (pN1) of disease. The recently announced eighth edition also includes stratification on the number of positive nodes. Furthermore, LNs detected on preoperative imaging (CT, MRI, or endoscopic ultrasound-EUS) are considered to be pathologically involved in other gastrointestinal cancers. However, this is less well defined for PDAC. Therefore, the three aims of this study were to determine (1) whether the new AJCC staging system led to more accurate staging, (2) the number of nodes needed to be examined to detect pathologic involvement, and (3) if pN disease could be reliably detected on preoperative imaging in PDAC. METHODS A retrospective review of all patients undergoing pancreatectomy at a single US academic center from January 1990 to September 2015. Pathology reports of resected specimens were reviewed to determine the total number of LNs examined and those positive for metastasis. CT, MRI, and/or EUS reports were used to determine the presence or absence of preoperatively detectable LN enlargement. RESULTS Of the 490 surgical resections for PDAC, pN1 disease was detected in 59.4% (n = 291) and was positively correlated with the number of LNs pathologically examined (P < 0.001). Patients with pN1 disease had a shorter overall survival (OS) than those without nodal involvement (25.1 vs. 44.0 months; P < 0.001); however, OS was not different when stratifying by the number of nodes as on the eighth AJCC system. Pathologic examination of > 20 LNs in treatment naïve patients was optimal to detect pN1 disease and predict longer OS for those without nodal involvement (median survival > 41.1 months, P = 0.03 when compared to < 15 or 15-19 LNs examined). LNs were detected by CT, MRI, or EUS in 30.7% (103/335) of patients. The positive predictive value (PPV) of preoperative LN detection for pathologic involvement was 77.3% for treatment naïve patients and 84.2% for those without biliary obstruction. CONCLUSIONS Although the LN scoring in the seventh PDAC AJCC Staging System was sufficient to predict OS of our patients, more LNs than previously considered (20 vs. 15) were optimal to detect pathologic involvement. Preoperative LN detection was an accurate predictor of pN1 disease for treatment naïve patients without biliary obstruction.
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Affiliation(s)
- Toshiro Masuda
- Department of Surgery, David Geffen School of Medicine, 10833 Le Conte Ave, CHS Room 72-215, PO Box 956904, Los Angeles, CA, 90095, USA.,Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-0811, Japan
| | - Amanda M Dann
- Department of Surgery, David Geffen School of Medicine, 10833 Le Conte Ave, CHS Room 72-215, PO Box 956904, Los Angeles, CA, 90095, USA
| | - Irmina A Elliott
- Department of Surgery, David Geffen School of Medicine, 10833 Le Conte Ave, CHS Room 72-215, PO Box 956904, Los Angeles, CA, 90095, USA
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjyo, Chuo-ku, Kumamoto, 860-0811, Japan
| | - Stephen Kim
- Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Alireza Sedarat
- Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA, USA
| | - V Raman Muthusamy
- Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Mark D Girgis
- Department of Surgery, David Geffen School of Medicine, 10833 Le Conte Ave, CHS Room 72-215, PO Box 956904, Los Angeles, CA, 90095, USA
| | - O Joe Hines
- Department of Surgery, David Geffen School of Medicine, 10833 Le Conte Ave, CHS Room 72-215, PO Box 956904, Los Angeles, CA, 90095, USA
| | - Howard A Reber
- Department of Surgery, David Geffen School of Medicine, 10833 Le Conte Ave, CHS Room 72-215, PO Box 956904, Los Angeles, CA, 90095, USA
| | - Timothy R Donahue
- Department of Surgery, David Geffen School of Medicine, 10833 Le Conte Ave, CHS Room 72-215, PO Box 956904, Los Angeles, CA, 90095, USA. .,Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, Los Angeles, CA, USA.
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16
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Contreras CM, Lin CP, Oster RA, Reddy S, Wang T, Vickers S, Heslin M. Increased pancreatic cancer survival with greater lymph node retrieval in the National Cancer Data Base. Am J Surg 2017; 214:442-449. [PMID: 28687101 DOI: 10.1016/j.amjsurg.2017.06.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/23/2017] [Accepted: 06/14/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND We evaluated the role of lymph node (LN) retrieval in pancreatic adenocarcinoma (PA) patients undergoing pancreaticoduodenectomy (PD). METHODS We utilized the National Cancer Data Base; Cox regression models and logistic regression models were used for statistical evaluation. RESULTS We evaluated 26,792 patients with PA who underwent PD. The mean LN retrieved in LN(-) patients was 10.8 vs 14.4 for LN(+) patients (P < 0.0001). Greater LN retrieval is an independent predictor of a negative microscopic margin and decreased length of stay. The median survival of LN(-) patients exceeded that of LN(+) patients (24.5 vs 15.1 months, P < 0.0001). Increasing LN retrieval is a significant predictor of survival in all patients, and in LN(-) patients. The relationship of increased LN retrieval and enhanced survival is a nearly linear trend. CONCLUSIONS Rather than demonstrating an inflection point that defines the extent of adequate lymphadenectomy, this dataset demonstrates an incremental relationship between LN retrieval and survival.
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Affiliation(s)
- Carlo M Contreras
- University of Alabama at Birmingham, Department of Surgery, Birmingham, AL, USA.
| | - Chee Paul Lin
- University of Alabama at Birmingham, Center for Clinical and Translational Science, Birmingham, AL, USA
| | - Robert A Oster
- University of Alabama at Birmingham, Department of Preventive Medicine, Birmingham, AL, USA
| | - Sushanth Reddy
- University of Alabama at Birmingham, Department of Surgery, Birmingham, AL, USA
| | - Thomas Wang
- University of Alabama at Birmingham, Department of Surgery, Birmingham, AL, USA
| | - Selwyn Vickers
- University of Alabama at Birmingham, Department of Surgery, Birmingham, AL, USA
| | - Martin Heslin
- University of Alabama at Birmingham, Department of Surgery, Birmingham, AL, USA
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17
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Sperti C, Gruppo M, Blandamura S, Valmasoni M, Pozza G, Passuello N, Beltrame V, Moletta L. Para-aortic node involvement is not an independent predictor of survival after resection for pancreatic cancer. World J Gastroenterol 2017; 23:4399-4406. [PMID: 28706422 PMCID: PMC5487503 DOI: 10.3748/wjg.v23.i24.4399] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 02/21/2017] [Accepted: 05/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To analyze the importance of para-aortic node status in a series of patients who underwent pancreaticoduodenectomy (PD) in a single Institution. METHODS Between January 2000 and December 2012, 151 patients underwent PD with para-aortic node dissection for pancreatic adenocarcinoma in our Institution. Patients were divided into two groups: patients with negative PALNs (PALNs-), and patients with metastatic PALNs (PALNs+). Pathologic factors, including stage, nodal status, number of positive nodes and lymph node ratio, invasion of para-aortic nodes, tumor's grading, and radicality of resection were studied by univariate and multivariate analysis. Survival curves were constructed with Kaplan-Meier method and compared with Log-rank test: significance was considered as P < 0.05. RESULTS A total of 107 patients (74%) had nodal metastases. Median number of pathologically assessed lymph nodes was 26 (range 14-63). Twenty-five patients (16.5%) had para-aortic lymph node involvement. Thirty-three patients (23%) underwent R1 pancreatic resection. One-hundred forty-one patients recurred and died for tumor recurrence, one is alive with recurrence, and 9 are alive and free of disease. Overall survival was significantly influenced by grading (P = 0.0001), radicality of resection (P = 0.001), stage (P = 0.03), lymph node status (P = 0.04), para-aortic nodes metastases (P = 0.02). Multivariate analysis showed that grading was an independent prognostic factor for overall survival (P = 0.0001), while grading (P = 0.0001) and radicality of resection (P = 0.01) were prognostic parameters for disease-free survival. Number of metastatic nodes, node ratio, and para-aortic nodes involvement were not independent predictors of disease-free and overall survival. CONCLUSION In this experience, lymph node status and para-aortic node metastases were associated with poor survival at univariate analysis, but they were not independent prognostic factors.
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18
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Lee H, Heo JS, Choi SH, Choi DW. Extended versus peripancreatic lymph node dissection for the treatment of left-sided pancreatic cancer. Ann Surg Treat Res 2017; 92:411-418. [PMID: 28580345 PMCID: PMC5453873 DOI: 10.4174/astr.2017.92.6.411] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/05/2016] [Accepted: 01/16/2017] [Indexed: 01/16/2023] Open
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.
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Affiliation(s)
- Huisong Lee
- Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jin Seok Heo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Ho Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Wook Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Eskander MF, de Geus SWL, Kasumova GG, Ng SC, Al-Refaie W, Ayata G, Tseng JF. Evolution and impact of lymph node dissection during pancreaticoduodenectomy for pancreatic cancer. Surgery 2017; 161:968-976. [PMID: 27865602 DOI: 10.1016/j.surg.2016.09.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/11/2016] [Accepted: 09/24/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Insufficient examination of lymph nodes after pancreaticoduodenectomy can lead some pancreatic cancer patients with N1 disease to be misclassified as N0. We examined trends in lymph node dissection throughout time and investigated how these changes affect lymph node status and its prognostic value. METHODS The National Cancer Data Base was queried for patients with nonmetastatic pancreatic adenocarcinoma (2004-2013) who underwent classic pancreaticoduodenectomy with antrectomy. Logistic regression was performed for odds of node positivity. Kaplan-Meier curves and Cox proportional hazards models were used to assess the impact of lymph node status on overall survival for patients diagnosed during 2-year intervals from 2004-2012. RESULTS Median number of examined lymph nodes was 10 (interquartile range 6-15) in 2004 vs 17 (interquartile range 12-24) in 2013. Number of lymph nodes examined was a significant predictor of N1 disease (P < .0001), with a plateau at 30 nodes. N1 disease increased from 64.4% to 68.0% (P < .0001). Survival for both N1 and N0 subgroups improved. In successive multivariate models, N0 versus N1 status was consistently protective for overall survival (P < .0001), but there was no change in the magnitude of its hazard ratio over time (overall hazard ratio 0.691; 95% confidence interval 0.660-0.723). CONCLUSION Contemporary patients have an adequate number of nodes examined during standard pancreaticoduodenectomy. This, along with rising rates of N1 cancer detection and improved survival for both node-positive and node-negative patients, suggest more accurate classification of lymph node status. However, no increased benefit is achieved beyond 30 nodes. Overall, lymph node status remains a strong prognosticator for overall survival.
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Affiliation(s)
- Mariam F Eskander
- Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Susanna W L de Geus
- Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Gyulnara G Kasumova
- Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Sing Chau Ng
- Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Waddah Al-Refaie
- Department of Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Gamze Ayata
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jennifer F Tseng
- Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
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20
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Peparini N. Para-Aortic Dissection in Pancreaticoduodenectomy with Mesopancreas Excision for Pancreatic Head Carcinoma: Not Only an N-Staging Matter. J Gastrointest Surg 2016; 20:1080-1. [PMID: 27000126 DOI: 10.1007/s11605-016-3131-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/09/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Nadia Peparini
- Nadia Peparini, Azienda Sanitaria Locale Roma H-Distretto 3, via Mario Calò, 5, 00043, Ciampino, Rome, Italy.
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21
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Fink DM, Steele MM, Hollingsworth MA. The lymphatic system and pancreatic cancer. Cancer Lett 2015; 381:217-36. [PMID: 26742462 DOI: 10.1016/j.canlet.2015.11.048] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/16/2015] [Accepted: 11/30/2015] [Indexed: 02/06/2023]
Abstract
This review summarizes current knowledge of the biology, pathology and clinical understanding of lymphatic invasion and metastasis in pancreatic cancer. We discuss the clinical and biological consequences of lymphatic invasion and metastasis, including paraneoplastic effects on immune responses and consider the possible benefit of therapies to treat tumors that are localized to lymphatics. A review of current techniques and methods to study interactions between tumors and lymphatics is presented.
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Affiliation(s)
- Darci M Fink
- Eppley Institute, University of Nebraska Medical Center, Omaha, NE 68198-5950, USA
| | - Maria M Steele
- Eppley Institute, University of Nebraska Medical Center, Omaha, NE 68198-5950, USA
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