Role of lymphadenectomy in resectable pancreatic cancer

Erdem, Suna; Bolli, Martin; Müller, Sascha; Flüe, Markus von; White, Rebekah R.; Worni, Mathias

doi:10.1007/s00423-020-01980-2

Cited by 10 publications

(6 citation statements)

References 85 publications

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“…Despite the fact that a few reports concluded that extended lymphadenectomies may provide a survival benefit, it is not clear if the extent of the lymphadenectomy affects survival or oncological results (14). However, a better stablished concept is that extended lymphadenectomies and the number of total LNs retrieval are at least crucial for proper tumor staging and survival prediction (prognostic information) (15).…”

Section: Discussionmentioning

confidence: 99%

First description of extended and tailored fluorescence-guided lymphadenectomy during robotic distal pancreatosplenectomy: case report

Surjan¹,

Silveira²,

Figueira³

et al. 2023

J Vis Surg

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Background: Minimally invasive distal pancreatosplenectomies for the treatment of pancreatic duct adenocarcinoma (PDAC) of the pancreatic body have become a well stablished approach. To improve oncologic resection and lymph node (LN) dissection, technical alternatives have emerged on the last few years, such as the radical antegrade modular pancreatosplenectomy (RAMPS). While it is accepted that 12 LNs should be retrieved during distal pancreatosplenectomies, during RAMPS procedure the mean harvest is described to be 21 LNs (range, 11-30). With the objective of performing extended and tailored lymphadenectomies during robotic distal pancreatosplenectomies, we developed a novel technique for LN dissection with the use of real-time near-infrared robotic fluorescence and direct injection of indocyanine green in the pancreas as a contrast agent.Case Description: The patient presented pathologically confirmed PDAC on the body of the pancreas and was submitted to totally robotic distal pancreatosplenectomy. After exposing the pancreatic body and under intraoperative sonography guidance, 1 mL of indocyanine green was injected on the pancreas just proximal to the tumor. Using robotic fluorescence, we could clearly identify the lymphatic drainage of the pancreatic body, in order to perform fluorescence guided, extended and tailored lymphadenectomy.Operative time was 4 hours and 43 minutes. Forty-three LNs were retrieved. Surgical margin was free from neoplasia. Postoperative period was uneventful.Conclusions: Fluorescence guided extended lymphadenectomy with intrapancreatic injection of indocyanine green is a novel technique that may improve oncological results and staging during robotic distal pancreatosplenectomies for the treatment of PDAC of the pancreatic body.

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Section: Discussionmentioning

confidence: 99%

First description of extended and tailored fluorescence-guided lymphadenectomy during robotic distal pancreatosplenectomy: case report

Surjan¹,

Silveira²,

Figueira³

et al. 2023

J Vis Surg

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“…PDAC patients have a high incidence of regional LN metastasis, with a positivity rate of up to 80% in those with resectable PDAC 25 . In this study, regional LN metastasis detected on preoperative imaging was a significant risk factor for early tumor recurrence, which is consistent with previous reports 13 , 15 .…”

Section: Discussionmentioning

confidence: 99%

Regional lymph node metastasis detected on preoperative CT and/or FDG-PET may predict early recurrence of pancreatic adenocarcinoma after curative resection

Yoon

Park

Kim

et al. 2022

Sci Rep

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The objective of this study was to evaluate the role of regional lymph node (LN) metastasis detected on preoperative CT and/or 18F-fluoro-2-deoxyglucose-positron emission tomography (FDG-PET) scans in the prediction of early tumor recurrence after curative surgical resection of pancreatic ductal adenocarcinoma (PDAC). This retrospective study included 137 patients who underwent upfront surgery with R0 resection of PDAC between 2013 and 2016. Regional LN metastasis was identified using two criteria: positive findings for regional LN metastasis on either preoperative CT or FDG-PET scans (LNOR), or on both preoperative CT and FDG-PET scans (LNAND). A total of 55 patients had early tumor recurrence within 12 months after curative resection. Univariable and multivariable Cox proportional hazard regression analysis showed that preoperative carbohydrate antigen 19–9 (CA19-9) levels, preoperative locally advanced status, and regional LN metastasis (both LNOR and LNAND criteria) were significant risk factors for early recurrence. Positive LNOR and LNAND showed significantly poorer recurrence-free survival compared to negative regional LN metastasis groups (p = 0.048 and p = 0.020, respectively). Compared with the LNAND criteria, the LNOR criteria provided higher sensitivity (22.4% vs. 15.5%, p = 0.046) and a higher negative predictive value (61.9% vs. 59.8%, p = 0.046). The LNOR definition provided more sensitive and accurate performance in diagnosing preoperative regional LN metastasis.

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“…In general, most randomized controlled trials (RCTs) to date didn't show any survival benefit supporting extended lymphadenectomy. It might even offer greater risk of postoperative morbidity, therefore, it is not recommended by most guidelines (59).…”

Section: Pd: Lymphadenectomymentioning

confidence: 99%

A more radical perspective on surgical approach and outcomes in pancreatic cancer—a narrative review

Fernandes¹,

Mello²,

Braga³

et al. 2023

J Gastrointest Oncol

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Background and Objective: Pancreatic adenocarcinoma remains a dismal disease and is expected to become an even greater burden in the near future. This review focuses on the different surgical aspects for pancreaticoduodenectomy (PD), distal and total pancreatectomy (TP), incorporating lessons from both the western and eastern visions in treating pancreatic cancer. Methods:We conducted an extensive literature review through PubMed, prioritizing papers published in the last 5 years, but older emblematic papers were also included. We included articles that explored the treatment of pancreatic adenocarcinoma, with focus on the surgical aspect and strategies to improve outcomes. References of selected articles were also reviewed to identify any missed studies. Only papers in English were included.

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Role of lymphadenectomy in resectable pancreatic cancer

Cited by 10 publications

References 85 publications

First description of extended and tailored fluorescence-guided lymphadenectomy during robotic distal pancreatosplenectomy: case report

First description of extended and tailored fluorescence-guided lymphadenectomy during robotic distal pancreatosplenectomy: case report

Regional lymph node metastasis detected on preoperative CT and/or FDG-PET may predict early recurrence of pancreatic adenocarcinoma after curative resection

A more radical perspective on surgical approach and outcomes in pancreatic cancer—a narrative review

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