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

Sahin, Tevfik Tolga; Fujii, Tsutomu; Kanda, Mitsuro; Nagai, Shunji; Kodera, Yasuhiro; Kanzaki, Akiyuki; Yamamura, Kazuo; Sugimoto, Hiroyuki; Kasuya, Hideki; Nomoto, Shuji; Takeda, Shin; Morita, Satoshi; Nakao, Akimasa

doi:10.1097/mpa.0b013e3182207893

Cited by 43 publications

(37 citation statements)

References 27 publications

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“…The impact of clusterin expression on survival can be too weak to be an independent prognostic factor, and further studies with a larger case volume may reveal the statistical significance. While extended lymphadenectomy did not show additional survival benefit [10], regional lymph node dissection still has a role in predicting the patient’s prognosis [11]. There are also cases in which pancreas adenocarcinoma was an incidental finding [34], and the extent of lymph node dissection can be quite varied depending on the operator.…”

Section: Discussionmentioning

confidence: 99%

Clinical significance of clusterin expression in pancreatic adenocarcinoma

Jin¹,

Kim²,

Hur³

et al. 2012

World J Surg Onc

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BackgroundClusterin is known to be expressed in many human neoplasms, and is believed to participate in the regeneration, migration, and anti-apoptosis of tumor cells. However, few reports have addressed the relationship between the manifestation of clusterin and clinicopathologic parameters in pancreas cancer patients. In the present study, the authors investigated the expression of clusterin and its clinical significance in pancreatic adenocarcinoma.MethodsImmunohistochemical staining was performed for clusterin in tumor tissues obtained from patients who received pancreatic resection with radical intent, and the associations of clusterin expression with various clinicopathologic parameters were analyzed in addition to the relation between its expression and survival.ResultsImmunoreactivity for clusterin was observed in 17 of the 52 (33%) pancreatic adenocarcinomas examined. In addition, clusterin positivity was found to be associated with preoperative serum carcinoembryonic antigen level, perineural invasion, and, most strongly, lymph node metastasis. The survival analysis identified tumor differentiation and lymph node metastasis as the only significant prognostic factors.ConclusionAlthough not an independent prognostic factor, clusterin immunoreactivity can be used in conjunction with lymph node metastasis to predict survival in cases of pancreatic adenocarcinoma.

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Section: Discussionmentioning

confidence: 99%

Clinical significance of clusterin expression in pancreatic adenocarcinoma

Jin¹,

Kim²,

Hur³

et al. 2012

World J Surg Onc

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“…The occurrence of a portal vein thrombosis was increased after ELA, however, without Patients were additionally randomized to standard (SLA) or extended lymphadenectomy (ELA). Data are given as mean ± SD especially the lymph node ratio (LNR) is an important predicting factor for the patients' outcome [25][26][27][28][29]. Therefore, a number of retrospective studies and well-designed randomized controlled trials evaluated the impact of the extent of lymphadenectomy in patients undergoing pancreaticoduodenectomy for periampullary carcinoma and especially adenocarcinoma of the pancreatic head [15,16,18,19,30,31].…”

Section: Postoperative Morbiditymentioning

confidence: 99%

Extended versus standard lymphadenectomy in patients undergoing pancreaticoduodenectomy for periampullary adenocarcinoma: a prospective randomized single center trial

et al. 2015

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Background Although randomized studies investigated the benefit of extended lymphadenectomy (ELA) compared to standard lymphadenectomy (SLA) for periampullary adenocarcinoma, these analyses failed to show overall advantage for ELA due to high heterogeneity of lymphadenectomy protocols. Therefore, the present single-center trial was designed using a standardized protocol for SLA with en bloc technique.Methods Patients undergoing pancreaticoduodenectomy for periampullary adenocarcinoma were randomized to either SLA or ELA. Primary study endpoint was recurrence-free survival. Secondary endpoints were overall survival as well as peri-and postoperative morbidity and mortality.Results Sixty-six out of 103 randomized patients were treated by SLA (n = 34) or ELA (n = 32) and included into final data analysis. ELA compared to SLA resulted in a higher number of removed lymph nodes (25 ± 12 vs. 14 ± 8; p < 0.001) with a comparable number of lymph node metastases (3 ± 5 vs. 2 ± 3). Median recurrence-free survival was comparable between SLA (18.7 months) and ELA (11.3 months) p = 0.445. Median overall survival was 22.1 months in the SLA group and 15.5 months in the ELA group. Overall survival rates after 9 and 18 months for SLA were 76.5 and 55.6 % and for ELA 68.8 and 46.9 %, respectively.Conclusion ELA for periampullary carcinomas resulted in a higher number of resected lymph nodes. This radical approach showed no benefit in terms of median recurrence-free and overall survival and therefore cannot be recommended in general.

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“…6 Several studies suggest that both the total number of PLN and the lymph node ratio are prognostic factors for PDAC, which emphasizes the importance of adequate lymph node retrieval at surgery, as well as the role of proper pathology examination of the specimen. [7][8][9][10] However, none of these studies assessed whether or not a standardized pathology examination (SPE) aimed at adequate staging of lymph node metastasis could increase the LNY. We hypothesize that if SPE is not associated with a higher LNY compared to non-standardized pathology examination (NSPE), this could be an argument for re-evaluating and modifying the laparoscopic technique to increase surgical radicality.…”

Section: Introductionmentioning

confidence: 99%

Can standardized pathology examination increase the lymph node yield following laparoscopic distal pancreatectomy for ductal adenocarcinoma?

Sahakyan

Haugvik

Røsok

et al. 2018

HPB

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

Abstract: These results indicate that the number and the ratio of metastatic LNs can be used to predict poor patient survival and as a staging strategy.

Cited by 43 publications

References 27 publications

Clinical significance of clusterin expression in pancreatic adenocarcinoma

Clinical significance of clusterin expression in pancreatic adenocarcinoma

Extended versus standard lymphadenectomy in patients undergoing pancreaticoduodenectomy for periampullary adenocarcinoma: a prospective randomized single center trial

Can standardized pathology examination increase the lymph node yield following laparoscopic distal pancreatectomy for ductal adenocarcinoma?

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