Survival of patients with periampullary carcinoma is predicted by lymph node 8a but not by lymph node 16b1 status

Connor, Saxon; Bosonnet, L.; Ghaneh, Paula; Alexakis, N.; Hartley, Mark; Campbell, Fiona; Sutton, Robert; Neoptolemos, John P.

doi:10.1002/bjs.4761

Cited by 60 publications

(63 citation statements)

References 56 publications

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“…The relative frequency of spread of cancer to this lymph node group has led to the advocacy of extended lymphadenectomy [28,29,30,31,32,33]. A recent study has shown that involvement of lymph node station 16 however carries no worse prognosis than involvement of more localized lymph node stations [59]. Two randomized trials have shown that although such additional lymphadenectomy does not lead to increased complications, there is no significant survival benefit [33, 34].…”

Section: Discussionmentioning

confidence: 99%

Influence of Surgical Resection and Post-Operative Complications on Survival following Adjuvant Treatment for Pancreatic Cancer in the ESPAC-1 Randomized Controlled Trial

et al. 2005

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Background/Aims: The influence of type of surgery and occurrence of post-operative complications on survival following adjuvant therapy for pancreatic cancer are uncertain. Methods: Cox proportional hazard modelling was used to investigate the influence of type of surgery and the presence of complications on survival in conjunction with clinico-pathological variables in the 550 patients of the ESPAC-1 adjuvant randomized controlled trial. Results: Standard Kausch-Whipple (KW) was performed in 282 (54%) patients, 186 (35%) had a pylorus-preserving (PP) KW, 39 (7%) had a distal pancreatectomy and 21 (4%) had a total pancreatectomy. Post-operative complications were reported in 140 (27%) patients. PP-KW patients survived longer with a median (95% CI) survival of 19.9 (17.3, 23.1) months compared to 14.8 (13.0, 16.7) for KW patients (χ²_LR = 15.1, p < 0.001). KW patients were more likely however to have R1 margins (67 (24%) vs. 29 (16%), χ² = 4.59, p = 0.032), poorly differentiated tumours (70 (26%) vs. 19 (10%), χ² = 18.65, p < 0.001) and positive lymph nodes (165 (60%) vs. 81 (44%), χ² = 11.32, p < 0.001). Post-operative complications did not significantly affect survival. Independent prognostic factors were tumour grade, nodal status and tumour size but not type of surgery or post-operative complications. There was a survival benefit for chemotherapy irrespective of the type of surgery or post-operative complications. Conclusions: The KW and PP-KW procedures did not significantly influence the hazard of death in the presence of tumour staging, demonstrating that ESPAC-1 surgeons showed good judgement in their choice of operation. Post-operative complications did not adversely affect the survival benefit from adjuvant chemotherapy.

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Section: Discussionmentioning

confidence: 99%

Influence of Surgical Resection and Post-Operative Complications on Survival following Adjuvant Treatment for Pancreatic Cancer in the ESPAC-1 Randomized Controlled Trial

et al. 2005

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“…Table 1 summarizes the characteristics of included studies. [18][19][20][21][22][23][24][25][26][27][28][29] One study was excluded due to overlap in its patient population with another study assessing additionally extraregional LNM. 29,30 No studies were excluded due to inadequate methodological quality (Supplementary Table).…”

Section: Study Selectionmentioning

confidence: 99%

“…In patients with N1-disease but without hepatic-artery LNM, median survival ranged from 16 to 21 months and 3-year survival was 23% among 60 patients in one study. 25 Estimated pooled mean survival was 15 [95%CI 12-18] months in 84 patients with hepatic-artery LNM compared to 19 [16][17][18][19][20][21][22] months in 270 patients with N1-disease without hepatic-artery LNM. Estimated pooled mean difference could be generated from 3 studies and was 3 [95%CI 0-5, p = 0.020] months.…”

Section: Hepatic-artery Lnm (Station 8a)mentioning

confidence: 99%

“…Three studies included patients with both pancreatic and periampullary cancer. 18,19,31 One study did not report separate survival times and was excluded from the sensitivity analysis. 18 For PDAC, estimated pooled mean survival was 13 [95%CI 5-21] months in 33 patients with hepatic-artery LNM compared to 15 [12][13][14][15][16][17][18][19] Studies included in qualitative synthesis n = 15…”

Section: Sensitivity Analysismentioning

confidence: 99%

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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

et al. 2016

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“…8,[30][31][32] Finally, 18 articles were included after reading the full papers (Table 1). 4,[15][16][17][18][19][33][34][35][36][37][38][39][40][41][42][43][44] …”

Section: Search Strategy and Study Identificationmentioning

confidence: 99%

Impact of tumor size on survival outcome of pancreatic carcinoma following pancreatic resection: A systematic review and meta-analysis

Shrestha

Baskota

et al. 2018

Asian J Med Sci

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A B S T R A C T REVIEW ARTICLE ASIAN JOURNAL OF MEDICAL SCIENCESThe aim of the study was to evaluate the influence of tumor size on long-term survival outcome of pancreatic tumors following pancreatic resection and the possibility of implementing another tumor size cut-off point in AJCC pancreatic tumor staging. Literature searches was conducted on electronic database to identify relevant studies on tumor size related survival outcome following pancreatic resection for pancreatic adenocarcinoma. Meta-analysis was done using the effect estimates and the use of 95% confidence intervals (CIs) was done to calculate the pooled risk estimates; heterogeneity among studies was examined using I 2 statistic. Total of 18 trials (13 retrospective and 5 prospective studies) including 6230 elderly patients was included in this study. The pooled HR of the tumor size with 2 cm cut-off was 1.43 with 95% CI of [1.27-1.62], I 2 = 17%, p<0.00001 and was statistically significant. Median survival for tumor size <2, >2, <3, >3, <4 and >4 were 41.02 months, 16.20 months, 19.41 months, 10.79 months, 24.2 months and 15.14 months respectively and the 1-, 3-, and 5-year survival rate decreased with increasing tumor diameter. Importantly, a total of four studies results indicated that 3-year survival rate and a total of five studies results indicated that 5-year survival rate had statistical significance with 3 cm cut-off. Tumor diameter of 2 cm seems to be a reasonable but relatively less comprehensive cut-off point. 3 cm cut-off maybe become a new potential tumor size cut-off point in addition to the current sole 2 cm cut-off point defining tumor stage.

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Survival of patients with periampullary carcinoma is predicted by lymph node 8a but not by lymph node 16b1 status

Cited by 60 publications

References 56 publications

Influence of Surgical Resection and Post-Operative Complications on Survival following Adjuvant Treatment for Pancreatic Cancer in the ESPAC-1 Randomized Controlled Trial

Influence of Surgical Resection and Post-Operative Complications on Survival following Adjuvant Treatment for Pancreatic Cancer in the ESPAC-1 Randomized Controlled Trial

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

Impact of tumor size on survival outcome of pancreatic carcinoma following pancreatic resection: A systematic review and meta-analysis

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