Value of regional lymphadenectomy in pancreatic cancer

Abstract

Radical surgical resection and adjuvant chemotherapy are the goal standard to attempt significant long term survival in patients suffering from ductal pancreatic cancer. The role of extended lymph-node dissection is still a debated issue. In this paper a deep review of the experiences reported in the literature is carried out. Several studies are limited, not randomized and retrospective: generally speaking they seem to suggest a positive role in node dissection. Unfortunately, this trend is not confirmed in the only two trials conducted in a prospective and randomized setting. Moreover the results of these studies are also difficult to compare. At the moment we can say that extended lymphadenectomy does not play a determinant role for long term survival but a positive trend has been shown for node positive patients.

Delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy: validation of International Study Group of Pancreatic Surgery classification and analysis of risk factors

“…Resection included the gallbladder, the pancreatic head with distal bile duct, the duodenum (except for the first portion), and the first jejunal loop. In all patients a standard lymphadenectomy was performed, which included dissection of the anterior and posterior pancreaticoduodenal, inferior head, pyloric, common bile duct, superior head, superior mesenteric and superior and inferior pancreatic body nodes 8 …”

Intraoperative Pancreatic Cancer Detection using Tumor-Specific Multimodality Molecular Imaging

“…Surgeons address two critical decisions during the procedure that will determine the long-term survival of pancreatic cancer: the absence of metastatic and regional disease and cancer-free margins. 3–5 However, margin-positive resections are a frequent phenomenon (which occurs up to 70% of cases), 6 as is the emergence of distant metastases soon after surgery. 7 Failure to identify small tumor extensions during surgery is not surprising, due to the growth pattern of the tumor and the inability of the surgeon to differentiate between tumor and (peritumoral) inflammation.…”

Photoacoustic Imaging in Gastroenterology: Advances and Needs

“…Treatment is usually done by surgical resection of the tumor, and only 20% of patients are eligible for resection at their initial diagnosis, due to locoregional spread and metastasis [38]. The 5-year survival rates can be significantly improved if the diagnosis is made at an early stage (no metastasis) and if the patient has cancer-free margins post-surgery [39,40]. When the diagnosis is made at an early stage, the tumor is usually small, well defined, and localized.…”