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Erschienen in: World Journal of Surgery 12/2021

18.08.2021 | Original Scientific Report

Impact of Lymph Node Metastases Around the Superior Mesenteric Artery on Postoperative Outcomes of Pancreatic Head Cancer

verfasst von: Yoichi Miyata, Naoto Yonamine, Ibuki Fujinuma, Takazumi Tsunenari, Yasuhiro Takihata, Toshimitsu Iwasaki, Takahiro Einama, Hironori Tsujimoto, Hideki Ueno, Junji Yamamoto, Yoji Kishi

Erschienen in: World Journal of Surgery | Ausgabe 12/2021

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Abstract

Background

The neural plexus and lymph nodes around the superior mesenteric artery (LN#14), are the most frequent sites involved by pancreatic head cancer. However the influence of metastases to LN#14 on patients’ prognosis has rarely been evaluated.

Methods

The patients who underwent pancreatectomy for pancreatic head cancer between January 2010 and December 2018 were selected. The patients with nodal metastases were classified into an LN#14 + or LN#14−group according to LN#14 metastasis. Clinical and pathological characteristics and prognosis were compared between the two groups.

Results

In total, 99 patients underwent pancreatectomy. Ninety-four patients were positive for lymph node metastases and 14 and 80 were classified as LN#14 + and LN#14 − , respectively. Postoperative median overall survival (OS) of the LN#14 + and LN#14 − groups was 10.2 and 31.1 months, respectively (P < 0.001). Median OS of the LN#14 + group was worse than that of patients with ≥ 4 metastatic nodes in the LN#14 − group (n = 35, 24.7 months, P = 0.002). In multivariate analysis, LN#14 + (hazard ratio [HR] = 3.89, 95% confidence interval [CI], 1.64–8.86) was one of the independent predictors of worse OS.

Conclusion

It might be feasible to recognize LN#14 metastases as an important prognostic factor independently from other regional lymph node metastases.
Literatur
1.
Zurück zum Zitat Murakami Y, Uemura K, Sudo T et al (2010) Number of metastatic lymph nodes, but not lymph node ratio, is an independent prognostic factor after resection of pancreatic carcinoma. J Am Coll Surg 211:196–204CrossRef Murakami Y, Uemura K, Sudo T et al (2010) Number of metastatic lymph nodes, but not lymph node ratio, is an independent prognostic factor after resection of pancreatic carcinoma. J Am Coll Surg 211:196–204CrossRef
2.
Zurück zum Zitat Strobel O, Hinz U, Gluth A et al (2015) Pancreatic adenocarcinoma: number of positive nodes allows to distinguish several N categories. Ann Surg 261:961–969CrossRef Strobel O, Hinz U, Gluth A et al (2015) Pancreatic adenocarcinoma: number of positive nodes allows to distinguish several N categories. Ann Surg 261:961–969CrossRef
3.
Zurück zum Zitat Slidell MB, Chang DC, Cameron JL et al (2008) Impact of total lymph node count and lymph node ratio on staging and survival after pancreatectomy for pancreatic adenocarcinoma: a large, population-based analysis. Ann Surg Oncol 15:165–174CrossRef Slidell MB, Chang DC, Cameron JL et al (2008) Impact of total lymph node count and lymph node ratio on staging and survival after pancreatectomy for pancreatic adenocarcinoma: a large, population-based analysis. Ann Surg Oncol 15:165–174CrossRef
4.
Zurück zum Zitat Zhan HX, Xu JW, Wang L et al (2015) Lymph node ratio is an independent prognostic factor for patients after resection of pancreatic cancer. World J Surg Oncol 13:105CrossRef Zhan HX, Xu JW, Wang L et al (2015) Lymph node ratio is an independent prognostic factor for patients after resection of pancreatic cancer. World J Surg Oncol 13:105CrossRef
5.
Zurück zum Zitat Brierley J D, Gospodarowicz M K,Wittekind C. (2017) In: International Union Against Cancer (UICC). TNM Classification of Malignant Tumors, Wiley, New York. Brierley J D, Gospodarowicz M K,Wittekind C. (2017) In: International Union Against Cancer (UICC). TNM Classification of Malignant Tumors, Wiley, New York.
6.
Zurück zum Zitat Cordera F, Arciero CA, Li T et al (2007) Significance of common hepatic artery lymph node metastases during pancreaticoduodenectomy for pancreatic head adenocarcinoma. Ann Surg Oncol 14:2330–2336CrossRef Cordera F, Arciero CA, Li T et al (2007) Significance of common hepatic artery lymph node metastases during pancreaticoduodenectomy for pancreatic head adenocarcinoma. Ann Surg Oncol 14:2330–2336CrossRef
7.
Zurück zum Zitat Philips P, Dunki-Jacobs E, Agle SC et al (2014) The role of hepatic artery lymph node in pancreatic adenocarcinoma: prognostic factor or a selection criterion for surgery. HPB (Oxford) 16:1051–1055CrossRef Philips P, Dunki-Jacobs E, Agle SC et al (2014) The role of hepatic artery lymph node in pancreatic adenocarcinoma: prognostic factor or a selection criterion for surgery. HPB (Oxford) 16:1051–1055CrossRef
8.
Zurück zum Zitat LaFemina J, Chou JF, Gonen M et al (2013) Hepatic arterial nodal metastases in pancreatic cancer: is this the node of importance? J Gastrointest Surg 17:1092–1097CrossRef LaFemina J, Chou JF, Gonen M et al (2013) Hepatic arterial nodal metastases in pancreatic cancer: is this the node of importance? J Gastrointest Surg 17:1092–1097CrossRef
9.
Zurück zum Zitat Paiella S, Malleo G, Maggino L et al (2015) Pancreatectomy with para-aortic lymph node dissection for pancreatic head adenocarcinoma: pattern of nodal metastasis spread and analysis of prognostic factors. J Gastrointest Surg 19:1610–1620CrossRef Paiella S, Malleo G, Maggino L et al (2015) Pancreatectomy with para-aortic lymph node dissection for pancreatic head adenocarcinoma: pattern of nodal metastasis spread and analysis of prognostic factors. J Gastrointest Surg 19:1610–1620CrossRef
10.
Zurück zum Zitat Raut CP, Tseng JF, Sun CC et al (2007) Impact of resection status on pattern of failure and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Ann Surg 246:52–60CrossRef Raut CP, Tseng JF, Sun CC et al (2007) Impact of resection status on pattern of failure and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Ann Surg 246:52–60CrossRef
11.
Zurück zum Zitat Inoue Y, Saiura A, Yoshioka R et al (2015) Pancreatoduodenectomy with systematic mesopancreas dissection using a supracolic anterior artery-first approach. Ann Surg 262:1092–1101CrossRef Inoue Y, Saiura A, Yoshioka R et al (2015) Pancreatoduodenectomy with systematic mesopancreas dissection using a supracolic anterior artery-first approach. Ann Surg 262:1092–1101CrossRef
12.
Zurück zum Zitat Deki H, Sato T (1988) An anatomic study of the peripancreatic lymphatics. Surg Radiol Anat 10:121–135CrossRef Deki H, Sato T (1988) An anatomic study of the peripancreatic lymphatics. Surg Radiol Anat 10:121–135CrossRef
13.
Zurück zum Zitat Kayahara M, Nagakawa T, Kobayashi H et al (1992) Lymphatic flow in carcinoma of the head of the pancreas. Cancer 70:2061–2066CrossRef Kayahara M, Nagakawa T, Kobayashi H et al (1992) Lymphatic flow in carcinoma of the head of the pancreas. Cancer 70:2061–2066CrossRef
14.
Zurück zum Zitat Nagakawa T, Kobayashi H, Ueno K et al (1994) Clinical study of lymphatic flow to the paraaortic lymph nodes in carcinoma of the head of the pancreas. Cancer 73:1155–1162CrossRef Nagakawa T, Kobayashi H, Ueno K et al (1994) Clinical study of lymphatic flow to the paraaortic lymph nodes in carcinoma of the head of the pancreas. Cancer 73:1155–1162CrossRef
16.
Zurück zum Zitat Society J P. In: Classification of Pancreatic Carcinoma, Kanehara & Co. Ltd, Tokyo. Society J P. In: Classification of Pancreatic Carcinoma, Kanehara & Co. Ltd, Tokyo.
17.
Zurück zum Zitat Motoi F, Kosuge T, Ueno H et al (2019) Randomized phase II/III trial of neoadjuvant chemotherapy with gemcitabine and S-1 versus upfront surgery for resectable pancreatic cancer (Prep-02/JSAP05). Jpn J Clin Oncol 49:190–194CrossRef Motoi F, Kosuge T, Ueno H et al (2019) Randomized phase II/III trial of neoadjuvant chemotherapy with gemcitabine and S-1 versus upfront surgery for resectable pancreatic cancer (Prep-02/JSAP05). Jpn J Clin Oncol 49:190–194CrossRef
18.
Zurück zum Zitat Yamada S, Fujii T, Hirakawa A et al (2016) Lymph node ratio as parameter of regional lymph node involvement in pancreatic cancer. Langenbecks Arch Surg 401:1143–1152CrossRef Yamada S, Fujii T, Hirakawa A et al (2016) Lymph node ratio as parameter of regional lymph node involvement in pancreatic cancer. Langenbecks Arch Surg 401:1143–1152CrossRef
19.
Zurück zum Zitat Pedrazzoli S, DiCarlo V, Dionigi R et al (1998) Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group Ann Surg 228:508–517 Pedrazzoli S, DiCarlo V, Dionigi R et al (1998) Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group Ann Surg 228:508–517
20.
Zurück zum Zitat Farnell MB, Pearson RK, Sarr MG et al (2005) A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery. 138:618–628 (discussion 628-630)CrossRef Farnell MB, Pearson RK, Sarr MG et al (2005) A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery. 138:618–628 (discussion 628-630)CrossRef
21.
Zurück zum Zitat Nimura Y, Nagino M, Takao S et al (2012) Standard versus extended lymphadenectomy in radical pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas: long-term results of a Japanese multicenter randomized controlled trial. J Hepatobiliary Pancreat Sci 19:230–241CrossRef Nimura Y, Nagino M, Takao S et al (2012) Standard versus extended lymphadenectomy in radical pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas: long-term results of a Japanese multicenter randomized controlled trial. J Hepatobiliary Pancreat Sci 19:230–241CrossRef
22.
Zurück zum Zitat Jang JY, Kang MJ, Heo JS et al (2014) 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 259:656–664CrossRef Jang JY, Kang MJ, Heo JS et al (2014) 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 259:656–664CrossRef
23.
Zurück zum Zitat Sakai M, Nakao A, Kaneko T et al (2005) Para-aortic lymph node metastasis in carcinoma of the head of the pancreas. Surgery 137:606–611CrossRef Sakai M, Nakao A, Kaneko T et al (2005) Para-aortic lymph node metastasis in carcinoma of the head of the pancreas. Surgery 137:606–611CrossRef
24.
Zurück zum Zitat Society J P (2019) In: Clinical Practice Guidelines for Pancreatic Cancer 2019. Kanehara & Co., Ltd, Tokyo Society J P (2019) In: Clinical Practice Guidelines for Pancreatic Cancer 2019. Kanehara & Co., Ltd, Tokyo
25.
Zurück zum Zitat Uesaka K, Boku N, Fukutomi A et al (2016) Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer: a phase 3, open-label, randomised, non-inferiority trial (JASPAC 01). Lancet 388:248–257CrossRef Uesaka K, Boku N, Fukutomi A et al (2016) Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer: a phase 3, open-label, randomised, non-inferiority trial (JASPAC 01). Lancet 388:248–257CrossRef
26.
Zurück zum Zitat Tol JA, Gouma DJ, Bassi C et al (2014) Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the international study group on pancreatic surgery (ISGPS). Surgery 156:591–600CrossRef Tol JA, Gouma DJ, Bassi C et al (2014) Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the international study group on pancreatic surgery (ISGPS). Surgery 156:591–600CrossRef
27.
Zurück zum Zitat Okada K, Murakami Y, Kondo N et al (2019) Prognostic significance of lymph node metastasis and micrometastasis along the left side of superior mesenteric artery in pancreatic head cancer. J Gastrointest Surg 23:2100–2109CrossRef Okada K, Murakami Y, Kondo N et al (2019) Prognostic significance of lymph node metastasis and micrometastasis along the left side of superior mesenteric artery in pancreatic head cancer. J Gastrointest Surg 23:2100–2109CrossRef
28.
Zurück zum Zitat Makino I, Kitagawa H, Ohta T et al (2008) Nerve plexus invasion in pancreatic cancer: spread patterns on histopathologic and embryological analyses. Pancreas 37:358–365CrossRef Makino I, Kitagawa H, Ohta T et al (2008) Nerve plexus invasion in pancreatic cancer: spread patterns on histopathologic and embryological analyses. Pancreas 37:358–365CrossRef
Metadaten
Titel
Impact of Lymph Node Metastases Around the Superior Mesenteric Artery on Postoperative Outcomes of Pancreatic Head Cancer
verfasst von
Yoichi Miyata
Naoto Yonamine
Ibuki Fujinuma
Takazumi Tsunenari
Yasuhiro Takihata
Toshimitsu Iwasaki
Takahiro Einama
Hironori Tsujimoto
Hideki Ueno
Junji Yamamoto
Yoji Kishi
Publikationsdatum
18.08.2021
Verlag
Springer International Publishing
Erschienen in
World Journal of Surgery / Ausgabe 12/2021
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-021-06276-0

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