Lymph Node Regions of Consequence in Distal Pancreatectomy: Can We Be Selective By Tumor Location?

Ishida et al., from the Saitama Cancer Center in Japan,¹ present a case series of distal pancreatectomies for cancer, with the goal of evaluating the optimal region of lymph node dissection by tumor location. By way of background, the authors note that extended lymph node dissection has not been found to be beneficial for pancreatic head cancers,² but that standards for distal pancreatectomy have not been established. Complicating decision making for nodal harvest in distal pancreatectomy is the fact that there are several described standards for this operation. Addressed here are the Japan Pancreas Society (JPS) standards for D2 lymph node dissection with distal pancreatectomy for cancer³ and the 2014 International Study Group on Pancreatic Surgery (ISGPS);⁴ the JPS standard calls for lymphadenectomy of both peripancreatic and non-peripancreatic lymph nodes, whereas the ISGPS calls for a standard lymphadenectomy to include the peripancreatic lymph nodes plus lymph node basin #9 if the tumor is in the pancreatic body. Thus, the authors sought to determine, via a single-center, retrospective study, the optimal region of lymph node dissection for left-sided pancreatic adenocarcinoma, hypothesizing that the resection of tail tumors might not need to include the full lymph node dissection and could focus on the lymph node basins more to the left (‘peripancreatic’ lymph nodes), and that the more extensive lymphadenectomy could be reserved for resection of pancreatic body cancers. …