Survival advantage with para aortic lymphadenectomy in peri-ampullary cancer: A retrospective cohort study

Bhatti, Abu Bakar Hafeez; Dar, Faisal Saud; Sahaab, Eraj; Khan, Nusrat Yar; Zia, Haseeb; Rana, Atif; Salih, Muhammad; Shah, Najmul Hassan

doi:10.1016/j.ijsu.2016.05.069

“…There are increasing reports of long-term survival after resection of pancreatic cancer with PALNS+[6,7,21,22], and, based on other prognostic parameters, more selective surgical indication has been suggested. Nappo et al[23] prospectively evaluated 135 patients undergoing PD and PALNs dissection, and found that survival of patients with PALNs+ seems to be comparable to that of patients with other lymph nodes involvement: the presence of PALNs+ should be not considered an absolute contraindication to radical surgery.…”

Section: Discussionmentioning

confidence: 99%

Para-aortic node involvement is not an independent predictor of survival after resection for pancreatic cancer

Sperti

¹

,

Gruppo

²

,

Blandamura

³

et al. 2017

WJG

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AIMTo analyze the importance of para-aortic node status in a series of patients who underwent pancreaticoduodenectomy (PD) in a single Institution.METHODSBetween January 2000 and December 2012, 151 patients underwent PD with para-aortic node dissection for pancreatic adenocarcinoma in our Institution. Patients were divided into two groups: patients with negative PALNs (PALNs-), and patients with metastatic PALNs (PALNs+). Pathologic factors, including stage, nodal status, number of positive nodes and lymph node ratio, invasion of para-aortic nodes, tumor’s grading, and radicality of resection were studied by univariate and multivariate analysis. Survival curves were constructed with Kaplan-Meier method and compared with Log-rank test: significance was considered as P < 0.05.RESULTSA total of 107 patients (74%) had nodal metastases. Median number of pathologically assessed lymph nodes was 26 (range 14-63). Twenty-five patients (16.5%) had para-aortic lymph node involvement. Thirty-three patients (23%) underwent R1 pancreatic resection. One-hundred forty-one patients recurred and died for tumor recurrence, one is alive with recurrence, and 9 are alive and free of disease. Overall survival was significantly influenced by grading (P = 0.0001), radicality of resection (P = 0.001), stage (P = 0.03), lymph node status (P = 0.04), para-aortic nodes metastases (P = 0.02). Multivariate analysis showed that grading was an independent prognostic factor for overall survival (P = 0.0001), while grading (P = 0.0001) and radicality of resection (P = 0.01) were prognostic parameters for disease-free survival. Number of metastatic nodes, node ratio, and para-aortic nodes involvement were not independent predictors of disease-free and overall survival.CONCLUSIONIn this experience, lymph node status and para-aortic node metastases were associated with poor survival at univariate analysis, but they were not independent prognostic factors.

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“…However excellent response to preoperative optimization with normalization of LFTs and improvement in ECOG after biliary drainage and HCV treatment signified possibility of a favorable outcome in this patient. It has been shown that high volume centers can have acceptable outcomes after PD even in challenging scenarios [7,8]. The authors believe that a high volume center, meticulous attention to surgical detail with minimal intra-operative blood loss, careful patient selection, use of broad spectrum antibiotics, salt and fluid restriction to prevent exacerbation of liver failure and simultaneous existence of an experienced liver transplant program [8] are some of the factors that had a positive impact on post-operative outcomes.…”

Section: Discussionmentioning

confidence: 99%

Successful outcome after Pancreaticodoudenectomy in an elderly cirrhotic patient: A case report

Sahaab

¹

,

Iqbal

²

,

Bhatti

³

2019

International Journal of Surgery Case Reports

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Highlights Pancreaticodoudenectomy in cirrhotic patients is seldom attempted. It is associated with high morbidity and mortality rates. Careful patient selection allows its safe performance in cirrhotic patients. Preoperative biliary drainages should always be considered. Liver cirrhosis is not an absolute contraindication to PD.

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“…On the other hand, extended lymphadenectomy failed the target of prolonging long term survival after PD for pancreatic head cancer [17][18][19][20] . There are increasing reports of long-term survival after resection of pancreatic cancer with PALNS+ [6,7,21,22] , and, based on other prognostic parameters, more selective surgical indication has been suggested. Nappo et al [23] prospectively evaluated 135 patients undergoing PD and PALNs dissection, and found that survival of patients with PALNs+ seems to be comparable to that of patients with other lymph nodes involvement: the presence of PALNs+ should be not considered an absolute contraindication to radical surgery.…”

Section: Discussionmentioning

confidence: 99%

Para-aortic node involvement is not an independent predictor of survival after resection for pancreatic cancer

Moletta

¹

,

Gruppo

²

,

Poletto

³

et al. 2017

Pancreatology

0

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AIMTo analyze the importance of para-aortic node status in a series of patients who underwent pancreaticoduodenectomy (PD) in a single Institution. METHODSBetween January 2000 and December 2012, 151 patients underwent PD with para-aortic node dissection for pancreatic adenocarcinoma in our Institution. Patients were divided into two groups: patients with negative PALNs (PALNs-), and patients with metastatic PALNs (PALNs+). Pathologic factors, including stage, nodal status, number of positive nodes and lymph node ratio, invasion of para-aortic nodes, tumor's grading, and radicality of resection were studied by univariate and multivariate analysis. Survival curves were constructed with Kaplan-Meier method and compared with Log-rank test: significance was considered as P < 0.05. RESULTSA total of 107 patients (74%) had nodal metastases. Median number of pathologically assessed lymph nodes was 26 (range 14-63). Twenty-five patients (16.5%) Retrospective Cohort Study had para-aortic lymph node involvement. Thirty-three patients (23%) underwent R1 pancreatic resection. Onehundred forty-one patients recurred and died for tumor recurrence, one is alive with recurrence, and 9 are alive and free of disease. Overall survival was significantly influenced by grading (P = 0.0001), radicality of resection (P = 0.001), stage (P = 0.03), lymph node status (P = 0.04), para-aortic nodes metastases (P = 0.02). Multivariate analysis showed that grading was an independent prognostic factor for overall survival (P = 0.0001), while grading (P = 0.0001) and radicality of resection (P = 0.01) were prognostic parameters for disease-free survival. Number of metastatic nodes, node ratio, and para-aortic nodes involvement were not independent predictors of disease-free and overall survival. ORIGINAL ARTICLE CONCLUSIONIn this experience, lymph node status and para-aortic node metastases were associated with poor survival at univariate analysis, but they were not independent prognostic factors. Core tip: Para-aortic node involvement by pancreatic cancer is traditionally considered as an advanced disease with poor prognosis. We retrospectively examined our experience of 151 patients with pancreatic cancer who underwent resection and para-aortic lymph nodes sampling. Disease-free and overall survival were worse in patients with para-aortic nodes metastases, but multivariate analysis showed that para-aortic node involvement is not an independent prognostic factor after resection of pancreatic cancer. So, the decision to make pancreatic resection should not be based on the paraaortic node status only.Sperti C, Gruppo M, Blandamura S, Valmasoni M, Pozza G, Passuello N, Beltrame V, Moletta L. Para-aortic node involvement is not an independent predictor of survival after resection for pancreatic cancer.

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Survival advantage with para aortic lymphadenectomy in peri-ampullary cancer: A retrospective cohort study

Abstract: Curative surgery may benefit some patients with pancreatic cancer and positive PALN and should be considered selectively.

Cited by 10 publications

References 33 publications

Para-aortic node involvement is not an independent predictor of survival after resection for pancreatic cancer

Para-aortic node involvement is not an independent predictor of survival after resection for pancreatic cancer

Successful outcome after Pancreaticodoudenectomy in an elderly cirrhotic patient: A case report

Para-aortic node involvement is not an independent predictor of survival after resection for pancreatic cancer

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