Prognostic value of lymph node metastases detected during surgical exploration for pancreatic or periampullary cancer: a systematic review and meta-analysis

Rijssen, L.B. van; Narwade, Poorvi; Huijgevoort, Nadine C.M. van; Tseng, Dorine S.J.; Santvoort, Hjalmar C. van; Molenaar, I. Quintus; Laarhoven, Hanneke W. M. van; Eijck, Casper H.J. van; Busch, Olivier R.; Besselink, Marc G.

doi:10.1016/j.hpb.2016.05.001

Cited by 22 publications

(14 citation statements)

References 46 publications

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“…The survival benefit of LN14cd dissection or prognostic value of LN14cd metastasis were not so clear as para-aortic lymph node (LN16), which was defined as the third station LNs according to the definition of the Japan Pancreas Society, equivalent to distant metastases and previous randomized controlled trials (RCT) pointed out that patients could not benefit from dissection of LN16 (22,23). Other studies suggest that patients with LN16 metastasis confirmed during surgical exploration undergo neoadjuvant treatment instead of continuing exploration (24). To better understand the prognostic effect of LN14cd, further studies, including larger number of patients, especially those with ventral pancreatic head cancer with LN14cd dissection, would be needed.…”

Section: Discussionmentioning

confidence: 99%

The Necessity of Dissection of No. 14 Lymph Nodes to Patients With Pancreatic Ductal Adenocarcinoma Based on the Embryonic Development of the Head of the Pancreas

Qian

Xie

et al. 2020

Front. Oncol.

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Objectives: Pancreaticoduodenectomy (PD) followed by lymphadenectomy is performed for patients with pancreatic ductal adenocarcinoma (PDAC) located in the head of the pancreas. Because the head of the pancreas could be divided into dorsal or ventral primordium in relation to embryonic development, the metastasis of lymph node (LN) may differ. In this retrospective study, we evaluated the impact of extended or standard LN dissection for PDAC located in ventral or dorsal primordia of the pancreatic head.

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Section: Discussionmentioning

confidence: 99%

The Necessity of Dissection of No. 14 Lymph Nodes to Patients With Pancreatic Ductal Adenocarcinoma Based on the Embryonic Development of the Head of the Pancreas

Qian

Xie

et al. 2020

Front. Oncol.

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“…The literature was recently reviewed in depth by van Rijssen et al 18 Based on this review, we considered two recent publications of prospectively collected series of routine sampling of PALN, with conflicting results, to shape the current discussion. The first study by Schwarz et al showed the results of a prospectively collected series with routine sampling of PALNs.…”

Section: Discussionmentioning

confidence: 99%

How to Approach Para-Aortic Lymph Node Metastases During Exploration for Suspected Periampullary Carcinoma: Resection or Bypass?

et al. 2020

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Background. Intraoperative para-aortic lymph node (PALN) sampling during surgical exploration in patients with suspected pancreatic head cancer remains controversial. Objective. The aim of this study was to assess the value of routine PALN sampling and the consequences of different treatment strategies on overall patient survival. Methods. A retrospective, multicenter cohort study was performed in patients who underwent surgical exploration for suspected pancreatic head cancer. In cohort A, the treatment strategy was to avoid pancreatoduodenectomy and to perform a double bypass procedure when PALN metastases were found during exploration. In cohort B, routinely harvested PALNs were not examined intraoperatively and pancreatoduodenectomy was performed

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“…A recent meta-analysis explored the prognostic value of lymph node metastases in pancreatic and periampullary cancer [19]. Most of the included studies focused on the impact of PALN metastasis; however, isolated survival data in cases of PALN metastases detected during surgical resection for non-pancreatic periampullary cancer were not provided.…”

Section: Discussionmentioning

confidence: 99%

Prognostic impact of para-aortic lymph node metastases in non-pancreatic periampullary cancer

et al. 2020

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Background: Resection of the para-aortic lymph node (PALN) group Ln16b1 during pancreatoduodenectomy remains controversial because PALN metastases are associated with a worse prognosis in pancreatic cancer patients. The present study aimed to analyze the impact of PALN metastases on outcome after non-pancreatic periampullary cancer resection. Methods: One hundred sixty-four patients with non-pancreatic periampullary cancer who underwent curative pancreatoduodenectomy or total pancreatectomy between 2005 and 2016 were retrospectively investigated. The data were supplemented with a systematic literature review on this topic. Results: In 67 cases, the PALNs were clearly assigned and could be histopathologically analyzed. In 10.4% of cases (7/67), tumor-infiltrated PALNs (PALN+) were found. Metastatic PALN+ stage was associated with increased tumor size (P = 0.03) and a positive nodal stage (P < 0.001). The median overall survival (OS) of patients with metastatic PALN and non-metastatic PALN (PALN-) was 24.8 and 29.5 months, respectively. There was no significant difference in the OS of PALN+ and pN1 PALN patients (P = 0.834). Patients who underwent palliative surgical treatment (n = 20) had a lower median OS of 13.6 (95% confidence interval 2.7-24.5) months. Including the systematic literature review, only 23 cases with PALN+ status and associated OS could be identified; the average survival was 19.8 months. Conclusion: PALN metastasis reflects advanced tumor growth and lymph node spread; however, it did not limit overall survival in single-center series. The available evidence of the prognostic impact of PALN metastasis is scarce and a recommendation against resection in these cases cannot be given.

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Prognostic value of lymph node metastases detected during surgical exploration for pancreatic or periampullary cancer: a systematic review and meta-analysis

Cited by 22 publications

References 46 publications

The Necessity of Dissection of No. 14 Lymph Nodes to Patients With Pancreatic Ductal Adenocarcinoma Based on the Embryonic Development of the Head of the Pancreas

The Necessity of Dissection of No. 14 Lymph Nodes to Patients With Pancreatic Ductal Adenocarcinoma Based on the Embryonic Development of the Head of the Pancreas

How to Approach Para-Aortic Lymph Node Metastases During Exploration for Suspected Periampullary Carcinoma: Resection or Bypass?

Prognostic impact of para-aortic lymph node metastases in non-pancreatic periampullary cancer

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