Skip to main content
Erschienen in: World Journal of Surgery 8/2013

01.08.2013

Extended Lymphadenectomy in Patients With Pancreatic Cancer Is Debatable

verfasst von: Gregory Sergeant, Emmanuel Melloul, Mickael Lesurtel, Michelle L. DeOliveira, Pierre-Alain Clavien

Erschienen in: World Journal of Surgery | Ausgabe 8/2013

Einloggen, um Zugang zu erhalten

Abstract

Lymph node staging is one of the most important factors in determining the prognosis after resection of pancreatic ductal adenocarcinoma. Despite ongoing efforts to further refine lymph node staging, the debate on the extent of lymphadenectomy during pancreaticoduodenectomy is still open. The purpose of this review was to summarize the evidence about performing standard lymphadenectomy during curative resection of pancreatic cancer. All four prospective randomized controlled trials published concluded that extended lymphadenectomy does not contribute to better oncologic outcome for patients with adenocarcinoma of the pancreatic head. Indeed, one major drawback of extended lymphadenectomy is the higher risk of persistent postoperative diarrhea. No prospective randomized studies could be found on the role of extended lymphadenectomy in patients with adenocarcinoma of the corpus and tail. Based on current evidence there is no indication that extended lymphadenectomy should be performed routinely during resection of pancreatic cancer.
Literatur
1.
Zurück zum Zitat Ferrone CR, Pieretti-Vanmarcke R, Bloom JP et al (2012) Pancreatic ductal adenocarcinoma: long-term survival does not equal cure. Surgery 152:S43–S49PubMedCrossRef Ferrone CR, Pieretti-Vanmarcke R, Bloom JP et al (2012) Pancreatic ductal adenocarcinoma: long-term survival does not equal cure. Surgery 152:S43–S49PubMedCrossRef
2.
Zurück zum Zitat Lim JE, Chien MW, Earle CC (2003) Prognostic factors following curative resection for pancreatic adenocarcinoma: a population-based, linked database analysis of 396 patients. Ann Surg 237:74–85PubMedCrossRef Lim JE, Chien MW, Earle CC (2003) Prognostic factors following curative resection for pancreatic adenocarcinoma: a population-based, linked database analysis of 396 patients. Ann Surg 237:74–85PubMedCrossRef
3.
Zurück zum Zitat Anonymous (2010) Exocrine pancreas. In: AJCC cancer staging manual, 7th edn. Springer, New York, p 285–296 Anonymous (2010) Exocrine pancreas. In: AJCC cancer staging manual, 7th edn. Springer, New York, p 285–296
4.
Zurück zum Zitat Schwarz RE, Smith DD (2006) Extent of lymph node retrieval and pancreatic cancer survival: information from a large US population database. Ann Surg Oncol 13:1189–1200PubMedCrossRef Schwarz RE, Smith DD (2006) Extent of lymph node retrieval and pancreatic cancer survival: information from a large US population database. Ann Surg Oncol 13:1189–1200PubMedCrossRef
5.
Zurück zum Zitat Estrella JS, Rashid A, Fleming JB et al (2012) Post-therapy pathologic stage and survival in patients with pancreatic ductal adenocarcinoma treated with neoadjuvant chemoradiation. Cancer 118:268–277PubMedCrossRef Estrella JS, Rashid A, Fleming JB et al (2012) Post-therapy pathologic stage and survival in patients with pancreatic ductal adenocarcinoma treated with neoadjuvant chemoradiation. Cancer 118:268–277PubMedCrossRef
6.
Zurück zum Zitat House M, Gönen M, Jarnagin W et al (2007) Prognostic significance of pathologic nodal status in patients with resected pancreatic cancer. J Gastrointest Surg 11:1549–1555PubMedCrossRef House M, Gönen M, Jarnagin W et al (2007) Prognostic significance of pathologic nodal status in patients with resected pancreatic cancer. J Gastrointest Surg 11:1549–1555PubMedCrossRef
7.
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 15:165–174PubMedCrossRef 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 15:165–174PubMedCrossRef
8.
Zurück zum Zitat Sierzega M, Popiela T, Kulig J et al (2006) The ratio of metastatic/resected lymph nodes is an independent prognostic factor in patients with node-positive pancreatic head cancer. Pancreas 33:240–245PubMedCrossRef Sierzega M, Popiela T, Kulig J et al (2006) The ratio of metastatic/resected lymph nodes is an independent prognostic factor in patients with node-positive pancreatic head cancer. Pancreas 33:240–245PubMedCrossRef
9.
Zurück zum Zitat Berger AC, Watson JC, Ross EA et al (2004) The metastatic/examined lymph node ratio is an important prognostic factor after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am Surg 70:235–240 discussion 240PubMed Berger AC, Watson JC, Ross EA et al (2004) The metastatic/examined lymph node ratio is an important prognostic factor after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am Surg 70:235–240 discussion 240PubMed
10.
Zurück zum Zitat Pawlik TM, Gleisner AL, Cameron JL et al (2007) Prognostic relevance of lymph node ratio following pancreaticoduodenectomy for pancreatic cancer. Surgery 141:610–618PubMedCrossRef Pawlik TM, Gleisner AL, Cameron JL et al (2007) Prognostic relevance of lymph node ratio following pancreaticoduodenectomy for pancreatic cancer. Surgery 141:610–618PubMedCrossRef
11.
Zurück zum Zitat Sergeant G, Ectors N, Fieuws S et al (2007) Prognostic relevance of extracapsular lymph node involvement in pancreatic ductal adenocarcinoma. Ann Surg Oncol 16:3070–3079CrossRef Sergeant G, Ectors N, Fieuws S et al (2007) Prognostic relevance of extracapsular lymph node involvement in pancreatic ductal adenocarcinoma. Ann Surg Oncol 16:3070–3079CrossRef
12.
Zurück zum Zitat Pai RK, Beck AH, Mitchem J et al (2011) Pattern of lymph node involvement and prognosis in pancreatic adenocarcinoma: direct lymph node invasion has similar survival to node-negative disease. Am J Surg Pathol 35:228–234PubMedCrossRef Pai RK, Beck AH, Mitchem J et al (2011) Pattern of lymph node involvement and prognosis in pancreatic adenocarcinoma: direct lymph node invasion has similar survival to node-negative disease. Am J Surg Pathol 35:228–234PubMedCrossRef
13.
Zurück zum Zitat Bogoevski D, Yekebas EF, Schurr P et al (2004) Mode of spread in the early phase of lymphatic metastasis in pancreatic ductal adenocarcinoma: prognostic significance of nodal microinvolvement. Ann Surg 240:993–1000 discussion 1000–1001PubMedCrossRef Bogoevski D, Yekebas EF, Schurr P et al (2004) Mode of spread in the early phase of lymphatic metastasis in pancreatic ductal adenocarcinoma: prognostic significance of nodal microinvolvement. Ann Surg 240:993–1000 discussion 1000–1001PubMedCrossRef
14.
Zurück zum Zitat Fortner JG (1973) Regional resection of cancer of the pancreas: a new surgical approach. Surgery 73:307–320PubMed Fortner JG (1973) Regional resection of cancer of the pancreas: a new surgical approach. Surgery 73:307–320PubMed
15.
Zurück zum Zitat Anonymous (2009) Japan pancreas society: classification of pancreatic carcinoma. Kanehara, Tokyo Anonymous (2009) Japan pancreas society: classification of pancreatic carcinoma. Kanehara, Tokyo
16.
Zurück zum Zitat Pavlidis TE, Pavlidis ET, Sakantamis AK (2011) Current opinion on lymphadenectomy in pancreatic cancer surgery. Hepatobiliary Pancreat Dis Int 10:21–25PubMedCrossRef Pavlidis TE, Pavlidis ET, Sakantamis AK (2011) Current opinion on lymphadenectomy in pancreatic cancer surgery. Hepatobiliary Pancreat Dis Int 10:21–25PubMedCrossRef
17.
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 228:508–517PubMedCrossRef 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 228:508–517PubMedCrossRef
18.
Zurück zum Zitat Yeo CJ, Cameron JL, Sohn TA et al (1999) Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short-term outcome. Ann Surg 229:613–622 discussion 622–614PubMedCrossRef Yeo CJ, Cameron JL, Sohn TA et al (1999) Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short-term outcome. Ann Surg 229:613–622 discussion 622–614PubMedCrossRef
19.
Zurück zum Zitat Yeo CJ, Cameron JL, Lillemoe KD et al (2002) Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma. Part 2. Randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg 236:355–366 discussion 366–358PubMedCrossRef Yeo CJ, Cameron JL, Lillemoe KD et al (2002) Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma. Part 2. Randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg 236:355–366 discussion 366–358PubMedCrossRef
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 628–630PubMedCrossRef 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 628–630PubMedCrossRef
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 19:230–241PubMedCrossRef 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 19:230–241PubMedCrossRef
22.
Zurück zum Zitat Michalski CW, Kleeff J, Wente MN et al (2007) Systematic review and meta-analysis of standard and extended lymphadenectomy in pancreaticoduodenectomy for pancreatic cancer. Br J Surg 94:265–273PubMedCrossRef Michalski CW, Kleeff J, Wente MN et al (2007) Systematic review and meta-analysis of standard and extended lymphadenectomy in pancreaticoduodenectomy for pancreatic cancer. Br J Surg 94:265–273PubMedCrossRef
23.
Zurück zum Zitat Evans DB, Farnell MB, Lillemoe KD et al (2009) Surgical treatment of resectable and borderline resectable pancreas cancer: expert consensus statement. Ann Surg Oncol 16:1736–1744PubMedCrossRef Evans DB, Farnell MB, Lillemoe KD et al (2009) Surgical treatment of resectable and borderline resectable pancreas cancer: expert consensus statement. Ann Surg Oncol 16:1736–1744PubMedCrossRef
24.
Zurück zum Zitat Sahin TT, Fujii T, Kanda M et al (2011) Prognostic implications of lymph node metastases in carcinoma of the body and tail of the pancreas. Pancreas 40:1029–1033PubMedCrossRef Sahin TT, Fujii T, Kanda M et al (2011) Prognostic implications of lymph node metastases in carcinoma of the body and tail of the pancreas. Pancreas 40:1029–1033PubMedCrossRef
25.
Zurück zum Zitat Valsangkar NP, Bush DM, Michaelson JS et al (2013) N0/N1, PNL, or LNR? The effect of lymph node number on accurate survival prediction in pancreatic ductal adenocarcinoma. J Gastrointest Surg 17:257–266PubMedCrossRef Valsangkar NP, Bush DM, Michaelson JS et al (2013) N0/N1, PNL, or LNR? The effect of lymph node number on accurate survival prediction in pancreatic ductal adenocarcinoma. J Gastrointest Surg 17:257–266PubMedCrossRef
26.
Zurück zum Zitat Peparini N, Chirletti P (2012) Extended lymphadenectomy does not improve prognosis in pancreatic carcinoma: is that really so? J Hepatobiliary Pancreat Sci 19:297–298 author reply 299PubMedCrossRef Peparini N, Chirletti P (2012) Extended lymphadenectomy does not improve prognosis in pancreatic carcinoma: is that really so? J Hepatobiliary Pancreat Sci 19:297–298 author reply 299PubMedCrossRef
27.
Zurück zum Zitat Van den Broeck A, Sergeant G, Ectors N et al (2009) Patterns of recurrence after curative resection of pancreatic ductal adenocarcinoma. Eur J Surg Oncol 35:600–604PubMedCrossRef Van den Broeck A, Sergeant G, Ectors N et al (2009) Patterns of recurrence after curative resection of pancreatic ductal adenocarcinoma. Eur J Surg Oncol 35:600–604PubMedCrossRef
28.
Zurück zum Zitat Asiyanbola B, Gleisner A, Herman JM et al (2009) Determining pattern of recurrence following pancreaticoduodenectomy and adjuvant 5-flurouracil-based chemoradiation therapy: effect of number of metastatic lymph nodes and lymph node ratio. J Gastrointest Surg 13:752–759PubMedCrossRef Asiyanbola B, Gleisner A, Herman JM et al (2009) Determining pattern of recurrence following pancreaticoduodenectomy and adjuvant 5-flurouracil-based chemoradiation therapy: effect of number of metastatic lymph nodes and lymph node ratio. J Gastrointest Surg 13:752–759PubMedCrossRef
29.
Zurück zum Zitat Cubilla AL, Fortner J, Fitzgerald PJ (1978) Lymph node involvement in carcinoma of the head of the pancreas area. Cancer 41:880–887PubMedCrossRef Cubilla AL, Fortner J, Fitzgerald PJ (1978) Lymph node involvement in carcinoma of the head of the pancreas area. Cancer 41:880–887PubMedCrossRef
30.
Zurück zum Zitat Kayahara M, Nagakawa T, Ueno K et al (1995) Surgical strategy for carcinoma of the pancreas head area based on clinicopathologic analysis of nodal involvement and plexus invasion. Surgery 117:616–623PubMedCrossRef Kayahara M, Nagakawa T, Ueno K et al (1995) Surgical strategy for carcinoma of the pancreas head area based on clinicopathologic analysis of nodal involvement and plexus invasion. Surgery 117:616–623PubMedCrossRef
31.
Zurück zum Zitat Ishikawa O, Ohigashi H, Sasaki Y et al (1997) Practical grouping of positive lymph nodes in pancreatic head cancer treated by an extended pancreatectomy. Surgery 121:244–249PubMedCrossRef Ishikawa O, Ohigashi H, Sasaki Y et al (1997) Practical grouping of positive lymph nodes in pancreatic head cancer treated by an extended pancreatectomy. Surgery 121:244–249PubMedCrossRef
32.
Zurück zum Zitat Yamada S, Nakao A, Fujii T et al (2009) Pancreatic cancer with paraaortic lymph node metastasis: a contraindication for radical surgery? Pancreas 38:e13–e17PubMedCrossRef Yamada S, Nakao A, Fujii T et al (2009) Pancreatic cancer with paraaortic lymph node metastasis: a contraindication for radical surgery? Pancreas 38:e13–e17PubMedCrossRef
33.
Zurück zum Zitat Russ AJ, Weber SM, Rettammel RJ et al (2010) Impact of selection bias on the utilization of adjuvant therapy for pancreas adenocarcinoma. Ann Surg Oncol 17:371–376PubMedCrossRef Russ AJ, Weber SM, Rettammel RJ et al (2010) Impact of selection bias on the utilization of adjuvant therapy for pancreas adenocarcinoma. Ann Surg Oncol 17:371–376PubMedCrossRef
34.
Zurück zum Zitat Strasberg SM, Drebin JA, Linehan D (2003) Radical antegrade modular pancreatosplenectomy. Surgery 133:521–527PubMedCrossRef Strasberg SM, Drebin JA, Linehan D (2003) Radical antegrade modular pancreatosplenectomy. Surgery 133:521–527PubMedCrossRef
Metadaten
Titel
Extended Lymphadenectomy in Patients With Pancreatic Cancer Is Debatable
verfasst von
Gregory Sergeant
Emmanuel Melloul
Mickael Lesurtel
Michelle L. DeOliveira
Pierre-Alain Clavien
Publikationsdatum
01.08.2013
Verlag
Springer US
Erschienen in
World Journal of Surgery / Ausgabe 8/2013
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-013-2064-z

Weitere Artikel der Ausgabe 8/2013

World Journal of Surgery 8/2013 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.