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©The Author(s) 2022.
World J Gastrointest Surg. Nov 27, 2022; 14(11): 1204-1218
Published online Nov 27, 2022. doi: 10.4240/wjgs.v14.i11.1204
Published online Nov 27, 2022. doi: 10.4240/wjgs.v14.i11.1204
Table 1 Extent of extended lymphadenectomy and standard lymphadenectomy in pancreatic head carcinoma
| Location | Standard lymphadenectomy | Extended lymphadenectomy |
| Superior pyloric (No.5) | O | O |
| Inferior pyloric (No.6) | O | O |
| Anterior CHA (No.8a) | O | O |
| Posterior CHA (No.8p) | X | O |
| Celiac axis (No.9) | X | O |
| Proper hepatic artery (No.12a) | X | O |
| Bile duct (No.12b) | O | O |
| Cystic duct (No.12c) | O | O |
| Portal vein (No.12p) | X | O |
| Posterior pancreaticoduodenal (No.13a-b) | O | O |
| Origin and right side of SMA (No.14a-b) | X | O |
| Left side of SMA(No.14c-d) | X | O |
| Celiac axis to IMA (No.16a2, No.16b1) | X | O |
| Anterior pancreaticoduodenal (No.17a-b) | O | O |
Table 2 General data between extended and standard lymphadenectomy group in pancreatic head carcinoma patients
| Variables | ELD group (n = 88) | SLD group (n = 128) | P value |
| Gender (male/female) | 51/37 | 73/55 | 0.893 |
| Age (yr) | 62.1 ± 11.0 | 64.6 ± 10.0 | 0.080 |
| TB (μmol/L) | 62.6 (15.3, 144.6) | 57.7 (12.7, 143.4) | 0.679 |
| CA19-9 (U/ml) | 161.8 (38.5, 544.9) | 202.1 (44.9, 773.2) | 0.342 |
| Intraoperative blood loss (mL) | 500 (400, 800) | 600 (400, 800) | 0.332 |
| Operation time (h) | 11.1 ± 2.8 | 11.0 ± 2.9 | 0.693 |
| Tumor size (cm) | 3.5 ± 1.4 | 3.5 ± 1.7 | 0.790 |
| Tumor differentiation (poorly/ modrately& highly) | 25/63 | 47/81 | 0.203 |
| Portal vein invasion (yes/no) | 47/41 | 69/59 | 0.943 |
| Lymph node metastasis (yes/no) | 54/34 | 91/37 | 0.135 |
| Retrieved lymph node count | 25 (18, 35) | 19 (14, 28) | 0.001 |
| Positive lymph node count | 1 (0, 4) | 2 (0, 3) | 0.614 |
| Resection margin (R0/R1) | 83/5 | 118/10 | 0.545 |
| Postoperative chemotherapy (yes/no) | 48/40 | 61/67 | 0.320 |
Table 3 Perioperative complications between extended and standard lymphadenectomy group in pancreatic head carcinoma patients
| Variables | ELD (n = 88) | SLD (n = 128) | P value |
| Perioperative death | 2 | 5 | 0.783 |
| Postoperative complications | 27 | 42 | 0.741 |
| Biochemical fistula | 3 | 6 | 0.908 |
| Pancreatic fistula (grade B/C) | 4 | 6 | 0.779 |
| DGE | 9 | 15 | 0.732 |
| Diarrhea | 22 | 4 | < 0.001 |
| Abdominal infection | 9 | 13 | 0.987 |
| Abdominal hemorrhage | 3 | 4 | 0.783 |
Table 4 General data between extended and standard lymphadenectomy group in pancreatic head carcinoma patients at different T stages
| Variables | T1 stage | T2 stage | T3 stage | ||||||
| ELD group (n = 16) | SLD group (n = 28) | P value | ELD group (n = 51) | SLD group (n = 76) | P value | ELD group (n = 21) | SLD group (n = 24) | P value | |
| Gender (male/female) | 10/6 | 14/14 | 0.423 | 32/19 | 46/30 | 0.801 | 9/12 | 13/11 | 0.449 |
| Age (yr) | 62.8 ± 12.4 | 64.1 ± 9.7 | 0.696 | 64.2 ± 9.8 | 64.7 ± 10.3 | 0.801 | 56.2 ± 10.9 | 64.8 ± 9.7 | 0.001 |
| TB (μmol/L) | 58.1 (16.8, 107.5) | 72.3 (28.1, 149.0) | 0.742 | 80.8 (14.6, 149.3) | 60.6 (12.7, 168.7) | 0.885 | 44.4 (13.0, 137.7) | 29.4 (10.3, 96.8) | 0.285 |
| CA19-9 (U/mL) | 115.9 (24.0, 262.8) | 92.5 (38.7, 312.5) | 0.817 | 152.7 (53.7, 545.9) | 207.0 (43.5, 1058.9) | 0.507 | 180.2 (39.6, 556.4) | 424.5 (77.8, 1285.6) | 0.270 |
| Intraoperative blood loss (mL) | 500 (400, 600) | 500 (400, 650) | 0.788 | 500 (400, 800) | 600 (400, 800) | 0.310 | 500 (400, 1000) | 550 (400, 1000) | 0.741 |
| Operation time (h) | 10.8 ± 3.5 | 9.5 ± 2.9 | 0.194 | 10.9 ± 2.5 | 11.3 ± 2.7 | 0.404 | 11.9 ± 3.0 | 11.6 ± 3.2 | 0.746 |
| Tumor size (cm) | 1.7 ± 0.4 | 1.8 ± 0.3 | 0.274 | 3.2 ± 0.5 | 3.4 ± 0.5 | 0.193 | 5.4 ± 1.0 | 6.1 ± 2.0 | 0.155 |
| Tumor differentiation (poorly/moderately-highly) | 2/14 | 11/17 | 0.126 | 14/37 | 24/52 | 0.619 | 9/12 | 12/12 | 0.632 |
| Portal vein invasion (yes/no) | 4/12 | 6/22 | 0.919 | 28/23 | 45/31 | 0.630 | 15/6 | 18/6 | 0.787 |
| Lymph node metastasis (yes/no) | 10/6 | 15/13 | 0.565 | 31/20 | 55/21 | 0.171 | 15/6 | 23/5 | 0.587 |
| Retrieved lymph node count | 21 (18, 32) | 15 (12, 19) | 0.004 | 26 (21, 33) | 23 (16, 31) | 0.509 | 25 (15, 40) | 20 (15, 30) | 0.030 |
| Positive lymph node count | 2 (0, 2) | 1 (0, 2) | 0.373 | 1 (0, 4) | 2 (0, 4) | 0.513 | 1 (0, 3) | 4 (1, 5) | 0.022 |
| Resection margin (R0/R1) | 16/0 | 28/0 | - | 48/3 | 68/8 | 0.555 | 19/2 | 22/2 | 0.700 |
| Postoperative chemotherapy (yes/no) | 6/10 | 15/13 | 0.305 | 29/22 | 36/40 | 0.294 | 13/8 | 10/14 | 0.175 |
Table 5 Perioperative complications between extended and standard lymphadenectomy group in pancreatic head carcinoma patients at different T stages
| Variable | T1 stage | T2 stage | T3 stage | ||||||
| ELD group (n = 16) | SLD group (n = 28) | P value | ELD group (n = 51) | SLD group (n = 76) | P value | ELD group (n = 21) | SLD group (n = 24) | P value | |
| Perioperative death | 0 | 1 | 1.000 | 2 | 4 | 0.938 | 0 | 0 | - |
| Postoperative complications | 4 | 12 | 0.391 | 14 | 25 | 0.514 | 9 | 5 | 0.111 |
| Biochemical fistula | 1 | 3 | 0.961 | 1 | 3 | 0.912 | 1 | 0 | 0.467 |
| Pancreatic fistula (grade B/C) | 0 | 3 | 0.463 | 4 | 3 | 0.585 | 0 | 0 | - |
| DGE | 2 | 4 | 0.771 | 4 | 10 | 0.349 | 3 | 1 | 0.506 |
| Diarrhea | 3 | 1 | 0.254 | 12 | 2 | < 0.001 | 7 | 1 | 0.031 |
| Abdominal infection | 1 | 3 | 0.961 | 5 | 8 | 0.895 | 3 | 2 | 0.874 |
| Abdominal hemorrhage | 0 | 1 | 1.000 | 3 | 3 | 0.938 | 0 | 0 | - |
Table 6 Univariate analysis of long-term prognosis in pancreatic head carcinoma patients at T3 stage
| Variables | Number (n = 45) | yr OS (%) | 3-yr OS (%) | χ2 | P value |
| Gender | 0.004 | 0.949 | |||
| Male | 22 | 46.8 | 13.7 | ||
| Female | 23 | 54.1 | 10.8 | ||
| Age (yr) | 2.192 | 0.139 | |||
| ≤ 60 | 22 | 60.2 | 20.1 | ||
| > 60 | 23 | 43.6 | 5.5 | ||
| CA19-9 (U/mL) | 1.504 | 0.220 | |||
| ≤ 37 | 9 | 59.3 | 29.6 | ||
| > 37 | 36 | 48.9 | 7.5 | ||
| Operation time (h) | 2.647 | 0.104 | |||
| ≤ 10 | 18 | 63.2 | 19.0 | ||
| > 10 | 27 | 42.5 | 6.1 | ||
| Intraoperative blood loss (mL) | 0.253 | 0.615 | |||
| ≤ 800 | 30 | 49.2 | 16.5 | ||
| > 800 | 15 | 55.9 | 0 | ||
| Tumor differentiation | 0.996 | 0.318 | |||
| Poorly | 21 | 39.3 | 8.2 | ||
| Moderately-highly | 24 | 59.9 | 15.0 | ||
| Lymph node metastasis | 5.542 | 0.019 | |||
| Yes | 34 | 42.9 | 7.9 | ||
| No | 11 | 77.8 | 25.9 | ||
| Positive lymph node count | 0.569 | 0.451 | |||
| ≤ 3 | 33 | 52.9 | 8.2 | ||
| > 3 | 12 | 46.3 | 23.1 | ||
| Portal vein invasion | 4.141 | 0.042 | |||
| Yes | 33 | 42.3 | 7.7 | ||
| No | 12 | 72.7 | 24.2 | ||
| Resection margin | 0.035 | 0.852 | |||
| R0 | 41 | 48.1 | 13.9 | ||
| R1 | 4 | 75.0 | 0 | ||
| Extent of lymphadenectomy | 7.843 | 0.005 | |||
| ELD | 21 | 65.3 | 21.8 | ||
| SLD | 24 | 36.1 | 0 | ||
| Postoperative chemotherapy | 0.027 | 0.869 | |||
| Yes | 23 | 41.5 | 11.9 | ||
| No | 22 | 61.2 | 12.4 |
Table 7 Cox multivariate regression analysis of long-term prognosis in pancreatic head carcinoma patients at T3 stage
| Variables | RR | 95%CI | P value |
| Lymph node metastasis | 1.915 | 0.724-5.063 | 0.190 |
| Portal vein system invasion | 2.471 | 1.028-5.942 | 0.043 |
| Extent of lymphadenectomy | 2.395 | 1.065-5.383 | 0.035 |
- Citation: Lyu SC, Wang HX, Liu ZP, Wang J, Huang JC, He Q, Lang R. Clinical value of extended lymphadenectomy in radical surgery for pancreatic head carcinoma at different T stages. World J Gastrointest Surg 2022; 14(11): 1204-1218
- URL: https://www.wjgnet.com/1948-9366/full/v14/i11/1204.htm
- DOI: https://dx.doi.org/10.4240/wjgs.v14.i11.1204