Locoregional Dissemination and Extended Lymphadenectomy in Pancreatic Cancer

Abstract

Carcinoma of the pancreas is characterized by the high frequency of intrapancreatic (from 75 to 100%) and extrapancreatic neural invasion (from 64 to 69%). Even small-sized tumors (T₁) show plexus invasion. Carcinoma of the pancreas is also associated with a high incidence (76%) of lymph node metastasis. The knowledge of local and regional tumor spread is mandatory in the planning of rational surgical treatment with the intention to cure. At present, it does not seem possible to predict the direction of lymph drainage leading to nodal involvement in different anatomical areas. However, the anterior and posterior pancreaticoduodenal areas are generally involved at first and nodes farther away from the primary tumor mostly show metastases only after involvement of the nearer nodes. We believe, radical pancreatoduodenectomy should be based on three aspects: wide lymph node dissection; radical retroperitoneal dissection, and pancreatectomy with an extirpation line left of the coeliac axis for tumors of the head and left pancreatectomy for tumors of the body and tail of the pancreas. Conclusions: Cure or long-term palliation of pancreatic cancer is generally possible only after complete erradication of the primary tumor, including its local and regional extensions.

Factors influencing survival after resection for ductal adenocarcinoma of the head of the pancreas

“…The usefulness of performing an extended lymphadenectomy and retroperitoneal soft-tissue clearance in conjunction with a pancreatoduodenal resection in the treatment of ductal adenocarcinoma of the head of the pancreas is still unknown. Published studies suggest a benefit for the procedure in terms of better long-term survival rates; however, these studies were retrospective [11][12][13][14]. The lack of randomized prospective trials involving a sufficient number of cases does not allow us to make any final conclusions.…”

Prognostic Implications of Lymph Node Metastases in Carcinoma of the Body and Tail of the Pancreas

“…27,28 Lymph node metastasis of the pancreatic head cancer tends to show a continuous and convergent pattern toward the superior mesenteric artery and the hepatic portal region, whereas pancreatic body and tail cancers tend to show a divergent pattern toward the celiac axis. 29 Through the splenic artery route, pancreatic body and tail cancers disseminate widely to the retroperitoneal region, para-aortic regions, and to other parts of the periglandular lymph nodes. 29 In the current study, most frequent sites of lymph node metastasis were Nos.…”

“…29 Through the splenic artery route, pancreatic body and tail cancers disseminate widely to the retroperitoneal region, para-aortic regions, and to other parts of the periglandular lymph nodes. 29 In the current study, most frequent sites of lymph node metastasis were Nos. 11, 14, 8, and 9 in decreasing order, which was consistent with previous reports.…”

“…11, 14, 8, and 9 in decreasing order, which was consistent with previous reports. 2,12,29 Current classifications of UICC and Japanese Pancreas Society for pancreatic cancer define ''N'' categories only based on anatomical location of the metastatic lymph nodes. In the latest UICC staging classification, N factor is classified into the following categories in pancreatic body and tail cancer: N0, no regional lymph node metastasis; and N1, lymph node metastasis in regional lymph nodes (which is equivalent to lymph node Nos.…”

Transcriptional tumor‐selective promoter targeting of E. coli purine nucleoside phosphorylase for pancreatic cancer suicide gene therapy

“…Current therapies, chemotherapy and radiotherapy, fail to cure efficiently cancer of the pancreas. They are only palliative and do not offer a significant benefit for long-term survival [1][2][3]. Given this dismal prognosis, there is an urgent need to explore and to develop more effective therapies.…”