Appropriate Lymph Node Dissection Sites for Cancer in the Body and Tail of the Pancreas: A Multicenter Retrospective Study

Tanaka, Kimitaka; Kimura, Yasutoshi; Hayashi, Tsuyoshi; Ambo, Yoshiyasu; Yoshida, Shigeo; Umemoto, Kazufumi; Murakami, Takeshi; Asano, Tomohiko; Nakamura, Tõru; Hirano, Satoshi

doi:10.3390/cancers14184409

Cited by 5 publications

(4 citation statements)

References 26 publications

(35 reference statements)

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“…A complete lymphadenectomy of these stations is not achieved with the Kimura or Warshaw techniques. However, unlike pancreaticoduodenectomy, contention remains as to the optimal lymphadenectomy for DP due to a lack of clinical trials 16,17 . The two cases of PDAC resected in this series, were small, medial tumours where likelihood of R0 resection was not threatened, and lymphadenectomy deemed appropriate based on ISGPS guidelines.…”

Section: Discussionmentioning

confidence: 95%

“…However, unlike pancreaticoduodenectomy, contention remains as to the optimal lymphadenectomy for DP due to a lack of clinical trials. 16,17 The two cases of PDAC resected in this series, were small, medial tumours where likelihood of R0 resection was not threatened, and lymphadenectomy deemed appropriate based on ISGPS guidelines. Recent data suggests that mRNA vaccination therapy response rates may be affected by splenectomy in treatment of PDAC.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic partial splenectomy in distal pancreatectomy may preserve splenic function

Bell‐Allen,

McNamara,

Bull

et al. 2024

ANZ Journal of Surgery

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IntroductionSplenectomy is known to carry a risk of infection with encapsulated organisms and associated sepsis. Current Australian guidelines recommend intensive vaccination schedules and long‐term antibiotic therapy. We postulate that in some clinical scenarios where distal pancreatectomy (DP) and splenectomy is being performed, a partial splenectomy is feasible. This may preserve splenic function and help retain immunocompetence.MethodsFive patients underwent laparoscopic distal pancreatectomy with partial splenectomy (LDPPS). The DP is performed with proximal division and resection of the splenic artery and vein. The inferior portion of the spleen is removed en bloc with the distal pancreas with ligasure and linear cutting staplers. The line of demarcation on the spleen after the division of the splenic artery identifies the portion supplied by the short gastric vessels. Temporary clamping of the short gastrics during splenic parenchymal transection reduces blood loss. All operations were completed laparoscopically and within 4 h.ResultsThe pathology of resected lesions includes a serous cystadenoma, a pseudocyst, an IPMN and two small medial pancreatic ductal adenocarcinomas. The benign lesions involved splenic vessels at the hilum, making Kimura or Warshaw procedures untenable. No patient required blood transfusion. One patient suffered a postoperative collection consistent with postoperative pancreatic fistula requiring a drain for 10 days. Follow‐up ranged from 6 to 24 months. Following surgery, all patients had a perfused splenic remnant on imaging and benign blood films, which suggests retained splenic function.ConclusionPreserving some spleen when performing distal pancreatectomy may provide long‐term benefits for patients.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Laparoscopic partial splenectomy in distal pancreatectomy may preserve splenic function

Bell‐Allen,

McNamara,

Bull

et al. 2024

ANZ Journal of Surgery

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“…Yi-Nan Shen et al constructs a nomogram for predicting the peripancreatic vein invasion in pancreatic head cancer patients. Additionally, the other tumor sites of PC such as the body and tail of the pancreas also occur lymphatic metastasis (Shi et al 2022 ; Tanaka et al 2022 , 2020 ), and a model for predicting the status of LNM in those tumor sites of PC is in need. The nomogram model constructed in our study could satisfy this requirement.…”

Section: Discussionmentioning

confidence: 99%

Nomogram for predicting the preoperative lymph node metastasis in resectable pancreatic cancer

Cheng

Kang

et al. 2023

J Cancer Res Clin Oncol

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Background Lymph node metastasis (LNM) is a critical prognostic factor in resectable pancreatic cancer (PC) patients, determining treatment strategies. This study aimed to develop a clinical model to adequately and accurately predict the risk of LNM in PC patients. Methods 13,200 resectable PC patients were enrolled from the SEER (Surveillance, Epidemiology, and End Results) database, and randomly divided into a training group and an internal validation group at a ratio of 7:3. An independent group (n = 62) obtained from The First Affiliated Hospital of Xinxiang Medical University was enrolled as the external validation group. The univariate and multivariate logistic regression analyses were used to screen independent risk factors for LNM. The minimum Akaike’s information criterion (AIC) was performed to select the optimal model parameters and construct a nomogram for assessing the risk of LNM. The performance of the nomogram was assessed by the receiver operating characteristics (ROC) curve, calibration plot, and decision curve analysis (DCA). In addition, an online web calculator was designed to assess the risk of LNM. Result A total of six risk predictors (including age at diagnosis, race, primary site, grade, histology, and T-stage) were identified and included in the nomogram. The areas under the curves (AUCs) [95% confidential interval (CI)] were 0.711 (95%CI: 0.700–0.722), 0.700 (95%CI: 0.683–0.717), and 0.845 (95%CI: 0.749–0.942) in the training, internal validation and external validation groups, respectively. The calibration curves showed satisfied consistency between nomogram-predicted LNM and actual observed LNM. The concordance indexes (C-indexes) in the training, internal, and external validation sets were 0.689, 0.686, and 0.752, respectively. The DCA curves of the nomogram demonstrated good clinical utility. Conclusion We constructed a nomogram model for predicting LNM in pancreatic cancer patients, which may help oncologists and surgeons to choose more individualized clinical treatment strategies and make better clinical decisions.

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“…[ 12 ]. This index is used to evaluate the therapeutic value of dissection of individual lymph node stations not only in gastric cancer surgery [ 13 ] but also in other solid organ cancer surgeries such as pancreatic cancer [ 14 ] or colorectal cancer [ 15 ]. The survival benefit gained by dissection of meso-jejunal lymph nodes was calculated by multiplying the frequency of metastasis at the meso-jejunal lymph node station and the 5-year overall survival rate of patients with metastasis at that station.…”

Section: Methodsmentioning

confidence: 99%

Meso-jejunal lymph node dissection has a survival benefit in patients with remnant gastric cancer

Choi

Lee

et al. 2023

PLoS ONE

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Background Clinical benefits of the meso-jejunal lymph node (MJLN) dissection in remnant gastric cancer (RGC) patients have not been fully established. Hence, in this retrospective study, we evaluated the survival benefit of MJLN dissection and prognostic significance of MJLN metastasis in RGC patients who underwent gastrojejunostomy reconstruction after their initial gastrectomy. Methods We retrospectively reviewed 391 patients who underwent surgery for RGC at our institution between 1996 and 2019. Among them, 60 patients had MJLN dissection. The index value of the survival benefit gained by dissection of the MJLN was calculated by multiplying the frequency of metastasis at the MJLN station and the 5-year overall survival rate (5YOS) of patients with metastasis at that station. When the metastatic rate or 5YOS exceeded 10%, dissection was recommended. An index value of dissection greater than 1.0 was considered significant. Results Total metastatic rate of MJLN was 35% (n = 21/60). Patients with MJLN metastasis had advanced pathologic stage compared to patients in the no-metastasis group (p < 0.001). In T2-T4 RGC patients, the metastatic rate of MJLN was 48.6% (n = 17/35), and their 5YOS was 28.4%. The calculated index value was 13.8. Also, patients with MJLN metastasis had a poorer overall survival than those without metastasis. MJLN metastasis was an independent prognostic factor of overall survival in multivariate analysis (HR 6.77, 95%CI 2.21–20.79, p = 0.001). Conclusion MJLN dissection should be considered for advanced RGC patients who underwent gastrojejunostomy after distal gastrectomy during their initial surgery according to the index value.

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Appropriate Lymph Node Dissection Sites for Cancer in the Body and Tail of the Pancreas: A Multicenter Retrospective Study

Cited by 5 publications

References 26 publications

Laparoscopic partial splenectomy in distal pancreatectomy may preserve splenic function

Laparoscopic partial splenectomy in distal pancreatectomy may preserve splenic function

Nomogram for predicting the preoperative lymph node metastasis in resectable pancreatic cancer

Meso-jejunal lymph node dissection has a survival benefit in patients with remnant gastric cancer

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