Impact of Lymph Node Involvement on Long-term Survival after R0 Pancreaticoduodenectomy for Ductal Adenocarcinoma of the Pancreas

Abstract

Pancreaticoduodenectomy remains the only potentially curative treatment for adenocarcinoma of the pancreas. The aim of this study was to analyze prognostic factors impacting survival after R0 pancreaticoduodenectomy for adenocarcinoma in the head of the pancreas. Between 1995 and 2002, a potentially curative (R0) pancreaticoduodenectomy with pancreatogastrostomy for ductal adenocarcinoma in the head of the pancreas was performed in 81 patients (42 women and 39 men) with a mean age of 64 years (range 35-84). Patients were identified from a prospective database and records were reviewed retrospectively. Postoperative mortality was 1%, and 40% of patients had complications. Median survival was 18 months, and the 5-year survival was 24%. Fifteen patients were alive at 5 years. Factors associated with poor survival in multivariate analysis were (1) two or more positive lymph nodes, (2) tumor diameter greater than 30 mm, and (3) age greater than 70 years. In patients with no or with one positive lymph node, the 5-year survival was 44%. On the other hand, in patients with two or more positive lymph nodes, both the 3- and 5-year survival was 5%. The main risk factor associated with poor survival after an R0 pancreaticoduodenectomy for adenocarcinoma in the head of pancreas was lymph node status: The presence of two or more positive lymph nodes was associated with decreased survival.

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

“…In most centers, patients with preoperatively detected extraregional LNM do not undergo resection. 9,10 A standard lymphadenectomy, which includes the hepatic-artery but not para-aortic lymph nodes, was recently defined by the International Study Group of Pancreatic Surgery (ISGPS). 11 As preoperative imaging is often not reliable to exclude LNM, intraoperative detection of extra-regional LNM regularly confronts surgeons with the decision to abort the exploration or continue with resection.…”

Identification of the Lymphatic Drainage Pathways from the Pancreatic Head Guided by Indocyanine Green Fluorescence Imaging during Pancreaticoduodenectomy

“…The only chance of cure for pancreatic cancer is surgical resection followed by adjuvant chemotherapy [4]; however, the 5-year survival rate of patients undergoing curative resection remains a mere 7–25% [1,2,3]. Especially lymph node metastasis is the most important prognostic factor in the patients after surgical resection of pancreatic cancer [5,6,7,8]. Therefore, many surgeons have tried to perform an extended lymphadectomy as one strategy for improving survival in the patients with pancreatic cancer [9,10,11,12], since Fortner [13] initially proposed ‘regional pancreatectomy as en-bloc resection for pancreatic cancer with the lymphatic vessels and great vessels’ in 1973.…”

Management of Delayed Post-Pancreaticoduodenectomy Arterial Bleeding: Interventional Radiological Treatment First

“…Although the prevalence of surgical mortality of pancreaticoduodenectomy (PD) has recently fallen to acceptable levels (0–5%) [1,2,3,4,5,6,7,8,9,10], the prevalence of mortality can reach 11–60% [10,11,12,13,14,15] if postoperative arterial bleeding occurs. Post-PD arterial bleeding usually happens late (>5 days postoperatively).…”