Significance of lymph node metastases in patients with pancreatic cancer undergoing curative resection

Delcore, Romano; Rodríguez, Francisco J.; Forster, Jameson; Hermreck, Arlo S.; Thomas, James H.

doi:10.1016/s0002-9610(96)00237-1

Cited by 85 publications

(60 citation statements)

References 23 publications

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“…Tumour differentiation is therefore a determinant of outcome, which suggests that tumour biology is important and even a 2-cm tumour confined to the pancreas will still have poor outcome if it is poorly differentiated. Accordingly, there is not conclusive evidence that an extended procedure with resection of retroperitoneal tissue and extensive lymph node and vascular resection translate into a prolonged survival [17, 18, 19, 20]. The type of surgery performed, whether with or without pylorus preservation, was not an important predictor of survival either; hence this supposed less lymphatic dissection of the pyloric and perigastric groups as well as the limited surgical margin of the proximal duodenum associated with the pylorus preservation procedure, would not have a major impact in patients survival [21, 22].…”

Section: Discussionmentioning

confidence: 99%

Favourable Prognostic Factors in a Large UK Experience of Adenocarcinoma of the Head of the Pancreas and Periampullary Region

et al. 2004

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Aims: To present the surgical experience in a regional unit, analysing the post-operative outcome, and determining risk factors for survival after pancreaticoduodenectomy for periampullary and pancreatic head carcinoma. Methods: Data were collected on 251 patients with pancreatic head adenocarcinoma (133), ampullary carcinomas (88) and distal common bile duct (30), between 1987 and 2002. Survival was calculated using the Kaplan-Meier method. Clinical, surgical and histopathological records were examined by univariate and multivariate analysis to identify the independent prognostic predictors of survival. Results: Median actuarial survival for carcinoma of the pancreatic head, ampulla and distal bile duct were 13.4, 35.5 and 16 months, respectively; p < 0.0001. On univariate analysis for the whole series, the age ≤60, tumour of the head of the pancreas, lymph node positive, resection margin R1, poorly differentiated tumours, and portal vein invasion significantly decreased survival. On multivariate analysis, poor tumour differentiation, surgical margin, lymph node metastases, and age independently influence survival. Mortality and morbidity were 4.8 and 29.9%, respectively. Conclusions: Pancreaticoduodenectomy for pancreatic and periampullary tumours is the only therapy that may cure patients and can be performed safely in centres with significant experience.

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Section: Discussionmentioning

confidence: 99%

Favourable Prognostic Factors in a Large UK Experience of Adenocarcinoma of the Head of the Pancreas and Periampullary Region

et al. 2004

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“…6,14 Currently, complete resection offers the only hope for long-term survival. In the past, radical pancreaticoduodenectomy has had an unacceptably high operative mortality rate.…”

Section: Commentmentioning

confidence: 99%

Endoscopic Ultrasound and Fine Needle Aspiration for the Evaluation of Pancreatic Masses

Suits

Frazee²,

Erickson³

1999

Arch Surg

123

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Hypothesis: Endoscopic ultrasound (EUS) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) are accurate for the preoperative staging of pancreatic ductal carcinoma.Design: Retrospective medical record review.Patients: A prospective registry of 98 patients having EUS-FNA for peripancreatic masses from April 1994 to April 1998 was analyzed.Main Outcome Measure: The accuracy of EUS-FNA for preoperative diagnosis and staging of peripancreatic neoplasms.Results: Ninety-eight patients, aged 41 to 91 years (mean age, 67 years) with peripancreatic masses were evaluated by EUS-FNA. All patients had initial computed tomography scanning with a mass seen in 49 patients, "fullness" to the pancreas in 28 patients, and no mass seen in 21 pa-tients. Evaluation with EUS-FNA revealed 22 benign lesions, 18 T2 masses, 37 T3 masses, 1 T4 mass, and 20 masses representing nonpancreatic tumors. Results of EUS-FNA of adjacent lymph nodes were positive in 27 patients. Twenty-seven patients had surgical resection or palliation permitting operative and pathologic staging. On comparison of EUS-FNA staging with surgical staging, 12 patients were the same stage, 14 patients were upstaged, and 1 patient was downstaged. The remaining patients who did not have surgery have been followed up for a mean of 15 months. Overall accuracy of EUS-FNA for differentiating benign from malignant masses was 96%.Conclusions: Endoscopic ultrasound-guided fine needle aspiration is a useful technique for the evaluation of pancreatic masses. It is highly accurate for differentiating between benign and malignant lesions and for predicting T stage, but is limited for predicting nodal status.

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“…Lymph node (LN) metastasis has been indicated as a major prognostic factor in resectable pancreatic cancer [1,2,3,4,5,6,7]. In previous investigations, vascular endothelial growth factor (VEGF)-C [8, 9] and VEGF-D [9] expression in pancreatic cancer cells was associated with LN metastasis.…”

Section: Introductionmentioning

confidence: 99%

Chemokine Receptor CCR7 Expression Correlates with Lymph Node Metastasis in Pancreatic Cancer

Nakata

Fukunaga²,

Noda³

et al. 2008

Oncology

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Aims: The clinical significance of chemokine receptor CCR7 expression in pancreatic ductal cancer was investigated. Methods: Immunohistochemical staining of 89 pancreatic cancers treated macroscopically with curative resection without hematogenous metastases or peritoneal dissemination were analyzed in association with clinicopathological data. Results: The positivity of CCR7 in pancreatic cancer was 32.6% (29/89). A significant correlation was detected between CCR7-positive expression and lymph node metastasis. Patients with CCR7-positive tumors had significantly shorter survival times than those with CCR7-negative tumors (median, 12.8 vs. 21.9 months, respectively; p = 0.0039). CCR7 expression was an independent prognostic factor (hazard ratio, 1.949; p = 0.0364) by multivariate survival analysis; however, it was not an indicator for any particular site of recurrence. Conclusion: The survival impact of CCR7 expression on resectable pancreatic cancer may be associated with lymphatic spread. The results from the present study should foster further investigation of treatments using an inhibitor for the CCR7 protein to improve the survival of pancreatic cancer.

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Significance of lymph node metastases in patients with pancreatic cancer undergoing curative resection

Cited by 85 publications

References 23 publications

Favourable Prognostic Factors in a Large UK Experience of Adenocarcinoma of the Head of the Pancreas and Periampullary Region

Favourable Prognostic Factors in a Large UK Experience of Adenocarcinoma of the Head of the Pancreas and Periampullary Region

Endoscopic Ultrasound and Fine Needle Aspiration for the Evaluation of Pancreatic Masses

Chemokine Receptor CCR7 Expression Correlates with Lymph Node Metastasis in Pancreatic Cancer

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