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26.11.2021 | Pancreatic Tumors

Optimal Region of Lymph Node Dissection in Distal Pancreatectomy for Left-Sided Pancreatic Cancer Based on Tumor Location

verfasst von: Hiroyuki Ishida, MD, Toshiro Ogura, MD, PhD, Amane Takahashi, MD, PhD, Ryoichi Miyamoto, MD, PhD, Shinichi Matsudaira, MD, PhD, Katsumi Amikura, MD, PhD, Minoru Tanabe, MD, PhD, Yoshiyuki Kawashima, MD, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 4/2022

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Abstract

Background

The optimal lymph node (LN) dissection for left-sided pancreatic cancer based on tumor location has remained unknown. In particular, the efficacy of LN dissection around the common hepatic artery and the celiac axis for distal tumors has not been established. This study was designed to elucidate the frequency and prognostic impact of LN metastasis, focusing on tumor location.

Methods

Data from 110 patients with invasive pancreatic cancer who underwent distal pancreatectomy between 2007 and 2020 were collected. We used a quantitative value―the distance between the left side of the portal vein and the right side of tumor (DPT)―to define the tumor location. LN stations were divided into two groups: peripancreatic lymph nodes (PLN) and non-PLN. We then analyzed the frequency of LN metastasis based on the tumor location and prognostic factors.

Results

Non-PLN metastasis was observed in 7.3% of patients. Non-PLN metastasis was found only in patients with a DPT < 20 mm. Patients with non-PLN metastasis exhibited a significantly worse prognosis than those with only-PLN metastasis (median survival time: 20.3 vs. 42.5 months, p = 0.048). Multivariate analysis for survival indicated that tumor size > 4 cm (hazard ratio [HR]: 2.23, p = 0.012) and metastasis in the non-PLN region (HR: 3.02, p = 0.015), and inability to undergo adjuvant chemotherapy (HR: 2.81, p = 0.0018) were also associated with poor prognosis.

Conclusions

Dissection of the non-PLN region can be avoided in selected patients with DPT ≥ 20 mm.

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Titel: Optimal Region of Lymph Node Dissection in Distal Pancreatectomy for Left-Sided Pancreatic Cancer Based on Tumor Location
verfasst von: Hiroyuki Ishida, MD
Toshiro Ogura, MD, PhD
Amane Takahashi, MD, PhD
Ryoichi Miyamoto, MD, PhD
Shinichi Matsudaira, MD, PhD
Katsumi Amikura, MD, PhD
Minoru Tanabe, MD, PhD
Yoshiyuki Kawashima, MD, PhD
Publikationsdatum: 26.11.2021
Verlag: Springer International Publishing
Erschienen in: Annals of Surgical Oncology / Ausgabe 4/2022
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-021-11108-5

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Optimal Region of Lymph Node Dissection in Distal Pancreatectomy for Left-Sided Pancreatic Cancer Based on Tumor Location