Greater lymph node retrieval and lymph node ratio impacts survival in resected pancreatic cancer

Mirkin, Katelin A.; Hollenbeak, Christopher S.; Wong, Joyce Y.

doi:10.1016/j.jss.2017.06.076

Cited by 30 publications

(22 citation statements)

References 17 publications

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“…Pooled analysis of our data demonstrated better survival in patients with low LNR as compared to a high value. We have mainly used an LNR of 0.2 as a cut-off, which has been validated in several studies [ 2 - 4 , 7 , 9 - 16 ]. The low heterogeneity in our studies further makes the result more noteworthy.…”

Section: Discussionmentioning

confidence: 99%

“…In recent times, LN ratio (LNR) is being evaluated as a prognostic indicator in several of the published studies apart from just using the number of positive LN [2][3][4][7][8][9][10][11][12][13][14][15][16][17][18]. The LNR is defined as the ratio of metastatic to the total number of harvested LNs, and it has emerged as an indicator of cancer-specific survival in recent years.…”

Section: Introductionmentioning

confidence: 99%

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Lymph Node Ratio as a Prognostic Marker in Pancreatic Cancer Survival: A Systematic Review and Meta-Analysis

Karjol

Chandranath

Jonnada

et al. 2020

Cureus

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The lymph node ratio (LNR) is defined as the ratio of number of positive lymph nodes to the total number of lymph nodes harvested during surgery. The objective of this article is to investigate the efficacy of LNR as a prognostic indicator of survival in pancreatic cancer patients who have undergone surgery by meta-analysis. Methods A systematic database search was performed in MEDLINE, Embase, and Google Scholar for relevant studies that reported LNR in pancreatic cancer. Two authors independently screened the relevant articles for selection and to extract data. All studies published in English up to April 2020 were obtained, and a total of 17,128 node-positive patients in 14 studies were included in this meta-analysis. RevMan software 5.3 (Cochrane Collaboration, the Nordic Cochrane Centre, Copenhagen, Denmark) was used for conducting all statistical analyses. Results This meta-analysis demonstrated that LNR > 0.2 significantly correlated with worse survival (hazard ratio [HR]: 1.84; 95% CI: 1.74-1.94; p ≤ 0.00001) in node-positive pancreatic cancer patients. Conclusions Our findings have demonstrated that a higher LNR is a predictor of poor survival and that LNR serves as an independent prognostic marker for assessing survival using a cutoff of 20%.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Lymph Node Ratio as a Prognostic Marker in Pancreatic Cancer Survival: A Systematic Review and Meta-Analysis

Karjol

Chandranath

Jonnada

et al. 2020

Cureus

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“…Assessment of lymph nodes pathologically is also evolving, changing the focus from number of positive nodes to lymph node ratio. Studies assessing the significance of number of nodes assessed, number of positive lymph nodes and lymph node ratio, have been carried out . A large study of 811 patients who underwent pancreatoduodenectomy for PDAC between 2001 and 2012 assessed these factors, and reported that the number of positive lymph nodes, rather than number of nodes assessed, or lymph node ratio, was the most accurate prognostic factor for survival .…”

Section: Discussionmentioning

confidence: 99%

“…Studies assessing the significance of number of nodes assessed, number of positive lymph nodes and lymph node ratio, have been carried out. [38][39][40] A large study of 811 patients who underwent pancreatoduodenectomy for PDAC between 2001 and 2012 assessed these factors, and reported that the number of positive lymph nodes, rather than number of nodes assessed, or lymph node ratio, was the most accurate prognostic factor for survival. 41 Another study of 119 patients undergoing pancreatectomy for PDAC, with regional lymph node dissection, also reported that the number of positive nodes, but not lymph node ratio was a more powerful prognostic factor.…”

Section: Discussionmentioning

confidence: 99%

Adjuvant chemotherapy and outcomes in patients with nodal and resection margin‐negative pancreatic ductal adenocarcinoma: A systematic review and meta‐analysis

Flaum

Valle

Amir

et al. 2019

Journal of Surgical Oncology

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Adjuvant chemotherapy (AC) following pancreatic carcinoma (PC) resection improves overall survival (OS). A systematic review identified 10 phase‐2/3 studies investigating AC in 3644 patients looking at the influence of nodal and resection status. AC significantly improved disease free survival, OS and 5‐year odds of death risk. There was greater survival benefit in patients PS 0 and with body/tail tumors. There was a nonsignificant effect in N − /N + patients on OS and no difference between R0/R1 patients.

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“…The diagnosis of pancreatic cancer located in the body-tail of the pancreas is often made when the tumor has already grown extensively or metastases are evident 6,7 . The few patients with a seemingly localized disease are those who could benefit from surgery, especially if negative resection margins are achieved 8 and an adequate number of lymph nodes is retrieved 9 .…”

Section: Introductionmentioning

confidence: 99%

Robot-Assisted Radical Antegrade Modular Pancreatosplenectomy Including Resection and Reconstruction of the Spleno-Mesenteric Junction

Napoli

Kauffmann

Menonna

et al. 2020

JoVE

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This article shows the technique of robot-assisted radical antegrade modular pancreatosplenectomy, including resection and reconstruction of the spleno-mesenteric junction, for cancer of the body-tail of the pancreas. The patient is placed supine with the legs parted and a pneumoperitoneum is established and maintained at 10 mmHg. To use the surgical system, four 8 mm ports and one 12 mm port are required. The optic port is placed at the umbilicus. The other ports are placed, on either side, along the pararectal line and the anterior axillary line at the level of the umbilical line. The assistant port (12 mm) is placed along the right pararectal line. Dissection begins by detaching the gastrocolic ligament, thus opening the lesser sac, and by a wide mobilization of the splenic flexure of the colon. The superior mesenteric vein is identified along the inferior border of the pancreas. Lymph node number 8a is removed to permit clear visualization of the common hepatic artery. A tunnel is then created behind the neck of the pancreas. To permit safe resection and reconstruction of the spleno-mesenteric junction, further preemptive dissection is required before dividing the pancreatic neck to bring in clear view all relevant vascular pedicles. Next, the splenic artery is ligated and divided, and the pancreatic neck is divided, with selective ligature of the pancreatic duct. After vein resection and reconstruction, dissection proceeds to complete the clearance of peripancreatic arteries that are peeled off from all lympho-neural tissues. Both celiac ganglia are removed en-bloc with the specimen. The Gerota fascia covering the upper pole of the left kidney is also removed en-bloc with the specimen. Division of short gastric vessels and splenectomy complete the procedure. A drain is left near the pancreatic stump. The round ligament of the liver is mobilized to protect the vessels. Video Link The video component of this article can be found at https://www.jove.com/video/60370/ 12 , the complexity of this procedure and the high rate of margin negative resection reported after robotic procedures 13 suggest that robotic assistance could be rewarding in this operation. We herein describe the technique for robotic assisted RAMPS, that was developed in a center with experience in thousands of robotic procedures and in over 350 robotic pancreatic resections. Protocol The procedure described herein was conducted in compliance with the guidelines set out by the Ethics Committee of Pisa University Hospital for robotic operations, including regulations on research activity.

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Greater lymph node retrieval and lymph node ratio impacts survival in resected pancreatic cancer

Cited by 30 publications

References 17 publications

Lymph Node Ratio as a Prognostic Marker in Pancreatic Cancer Survival: A Systematic Review and Meta-Analysis

Lymph Node Ratio as a Prognostic Marker in Pancreatic Cancer Survival: A Systematic Review and Meta-Analysis

Adjuvant chemotherapy and outcomes in patients with nodal and resection margin‐negative pancreatic ductal adenocarcinoma: A systematic review and meta‐analysis

Robot-Assisted Radical Antegrade Modular Pancreatosplenectomy Including Resection and Reconstruction of the Spleno-Mesenteric Junction

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