SpringerLink
Log in

Optimal Region of Lymph Node Dissection in Distal Pancreatectomy for Left-Sided Pancreatic Cancer Based on Tumor Location

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The optimal lymph node (LN) dissection for left-sided pancreatic cancer based on tumor location has remained unknown. In particular, the efficacy of LN dissection around the common hepatic artery and the celiac axis for distal tumors has not been established. This study was designed to elucidate the frequency and prognostic impact of LN metastasis, focusing on tumor location.

Methods

Data from 110 patients with invasive pancreatic cancer who underwent distal pancreatectomy between 2007 and 2020 were collected. We used a quantitative value―the distance between the left side of the portal vein and the right side of tumor (DPT)―to define the tumor location. LN stations were divided into two groups: peripancreatic lymph nodes (PLN) and non-PLN. We then analyzed the frequency of LN metastasis based on the tumor location and prognostic factors.

Results

Non-PLN metastasis was observed in 7.3% of patients. Non-PLN metastasis was found only in patients with a DPT < 20 mm. Patients with non-PLN metastasis exhibited a significantly worse prognosis than those with only-PLN metastasis (median survival time: 20.3 vs. 42.5 months, p = 0.048). Multivariate analysis for survival indicated that tumor size > 4 cm (hazard ratio [HR]: 2.23, p = 0.012) and metastasis in the non-PLN region (HR: 3.02, p = 0.015), and inability to undergo adjuvant chemotherapy (HR: 2.81, p = 0.0018) were also associated with poor prognosis.

Conclusions

Dissection of the non-PLN region can be avoided in selected patients with DPT ≥ 20 mm.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA Cancer J Clin. 2021;71(1):7–33. https://doi.org/10.3322/caac.21654.

    Article  PubMed  Google Scholar 

  2. Yeo CJ, Cameron JL, Sohn TA, et al. Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short-term outcome. Ann Surg. 1999;229(5):613–24. https://doi.org/10.1097/00000658-199905000-00003.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Yeo CJ, Cameron JL, Lillemoe KD, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg. 2002;236(3):355.

    Article  Google Scholar 

  4. Farnell MB, Pearson RK, Sarr MG, et al. A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery. 2005;138(4):618–30.

    Article  Google Scholar 

  5. Nimura Y, Nagino M, Takao S, et al. Standard versus extended lymphadenectomy in radical pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas. J Hepatobiliary Pancreat Sci. 2012;19(3):230–41.

    Article  Google Scholar 

  6. Jang J-Y, Kang MJ, Heo JS, et al. A prospective randomized controlled study comparing outcomes of standard resection and extended resection, including dissection of the nerve plexus and various lymph nodes, in patients with pancreatic head cancer. Ann Surg. 2014;259(4):656–64.

    Article  Google Scholar 

  7. Jang J, Kang JS, Han Y, et al. Long-term outcomes and recurrence patterns of standard versus extended pancreatectomy for pancreatic head cancer: a multicenter prospective randomized controlled study. J Hepato-biliary-pancreatic Sci. 2017;24(7):426–33.

    Article  Google Scholar 

  8. Japan Pancreas Society. Classification of pancreatic carcinoma. In: The Japan Pancreas Society: Classification of Pancreatic Carcinoma; 2017.

  9. Tol JAMG, Gouma DJ, Bassi C, et al. Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surg (United States). 2014;156(3):591–600. https://doi.org/10.1016/j.surg.2014.06.016.

    Article  Google Scholar 

  10. Nakao A, Harada A, Nonami T, et al. Lymph node metastasis in carcinoma of the body and tail of the pancreas. Br J Surg. 1997;84(8):1090–2. https://doi.org/10.1002/bjs.1800840813.

    Article  CAS  PubMed  Google Scholar 

  11. Fujita T, Nakagohri T, Gotohda N, et al. Evaluation of the prognostic pactors and significance of lymph node status in invasive ductal carcinoma of the body or tail of the pancreas. Pancreas. 2010;39(1):48–54. https://doi.org/10.1097/MPA.0b013e3181bd5cfa.

    Article  Google Scholar 

  12. Sahin TT, Fujii T, Kanda M, et al. Prognostic implications of lymph node metastases in carcinoma of the body and tail of the pancreas. Pancreas. 2011;40(7):1029–33. https://doi.org/10.1097/MPA.0b013e3182207893.

    Article  PubMed  Google Scholar 

  13. Kanda M, Fujii T, Nagai S, et al. Pattern of lymph node metastasis spread in pancreatic cancer. Pancreas. 2011;40(6):951–5. https://doi.org/10.1097/MPA.0b013e3182148342.

    Article  PubMed  Google Scholar 

  14. Tanaka K, Nakamura T, Asano T, et al. Pancreatic body and tail cancer and favorable metastatic lymph node behavior on the left edge of the aorta. Pancreatology. 2020;20(7):1451–7. https://doi.org/10.1016/j.pan.2020.08.014.

    Article  PubMed  Google Scholar 

  15. Imamura T, Yamamoto Y, Sugiura T, et al. Reconsidering the optimal regional lymph node station according to tumor location for pancreatic cancer. Ann Surg Oncol. 2021;28(3):1602–11. https://doi.org/10.1245/s10434-020-09066-5.

    Article  PubMed  Google Scholar 

  16. Yamada S, Takeda S, Fujii T, et al. Clinical implications of peritoneal cytology in potentially resectable pancreatic cancer: positive peritoneal cytology may not confer an adverse prognosis. Ann Surg. 2007;246(2):254–8. https://doi.org/10.1097/01.sla.0000261596.43439.92.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Yoshioka R, Saiura A, Koga R, et al. The implications of positive peritoneal lavage cytology in potentially resectable pancreatic cancer. World J Surg. 2012;36(9):2187–91. https://doi.org/10.1007/s00268-012-1622-0.

    Article  PubMed  Google Scholar 

  18. Yamada S, Fujii T, Kanda M, et al. peritoneal cytology in potentially resectable pancreatic cancer. Br J Surg. 2013;100(13):1791–6.

    Article  CAS  Google Scholar 

  19. Strasberg SM, Linehan DC, Hawkins WG. Radical antegrade modular pancreatosplenectomy procedure for adenocarcinoma of the body and tail of the pancreas: ability to obtain negative tangential margins. J Am Coll Surg. 2007;204(2):244–9.

    Article  Google Scholar 

  20. Strasberg SM, Drebin JA, Linehan D. Radical antegrade modular pancreatosplenectomy. Surgery. 2003;133(5):521–7.

    Article  Google Scholar 

  21. Unno M, Motoi F, Matsuyama Y, et al. Randomized phase II/III trial of neoadjuvant chemotherapy with gemcitabine and S-1 versus upfront surgery for resectable pancreatic cancer (Prep-02/JSAP-05). 2019.

  22. Ielpo B, Duran H, Diaz E, et al. Preoperative treatment with gemcitabine plus nab-paclitaxel is a safe and effective chemotherapy for pancreatic adenocarcinoma. Eur J Surg Oncol. 2016;42(9):1394–400.

    Article  CAS  Google Scholar 

  23. Conroy T, Desseigne F, Ychou M, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364(19):1817–25.

    Article  CAS  Google Scholar 

  24. Oettle H, Neuhaus P, Hochhaus A, et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: The CONKO-001 randomized trial. JAMA—J Am Med Assoc. 2013;310(14):1473–81. https://doi.org/10.1001/jama.2013.279201.

    Article  CAS  Google Scholar 

  25. Uesaka K, Boku N, Fukutomi A, et al. Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer: a phase 3, open-label, randomised, non-inferiority trial (JASPAC 01). Lancet. 2016;388(10041):248–57. https://doi.org/10.1016/S0140-6736(16)30583-9.

    Article  CAS  PubMed  Google Scholar 

  26. Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. New York: Wiley; 2017.

    Google Scholar 

  27. Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant. 2013;48(3):452–8. https://doi.org/10.1038/bmt.2012.244.

    Article  CAS  Google Scholar 

  28. Strobel O, Hinz U, Gluth A, et al. Pancreatic adenocarcinoma: number of positive nodes allows to distinguish several N categories. Ann Surg. 2015;261(5):961–9. https://doi.org/10.1097/SLA.0000000000000814.

    Article  PubMed  Google Scholar 

  29. Warschkow R, Tsai C, Köhn N, et al. Role of lymphadenectomy, adjuvant chemotherapy, and treatment at high-volume centers in patients with resected pancreatic cancer—a distinct view on lymph node yield. Langenbeck’s Arch Surg. 2020;405(1):43–54. https://doi.org/10.1007/s00423-020-01859-2.

    Article  Google Scholar 

  30. Malleo G, Maggino L, Nobile S, et al. Reappraisal of nodal staging and study of lymph node station involvement in distal pancreatectomy for body-tail pancreatic ductal adenocarcinoma. Eur J Surg Oncol. 2020;46(9):1734–41. https://doi.org/10.1016/j.ejso.2020.04.006.

    Article  PubMed  Google Scholar 

  31. Sasako M, McCulloch P, Kinoshita T, Maruyama K. New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg. 1995;82(3):346–51. https://doi.org/10.1002/bjs.1800820321.

    Article  CAS  PubMed  Google Scholar 

  32. Zhou Y, Lin J, Wang W, et al. Should a standard lymphadenectomy include the No. 9 lymph nodes for body and tail pancreatic ductal adenocarcinoma? Pancreatology. 2019;19(3):414–48. https://doi.org/10.1016/j.pan.2019.03.005.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Editage (www.editage.com) for English language editing.

Funding

The authors affirm that they have no financial or personal affiliations or other involvement with any commercial organization that has a direct financial interest in any matter included in this manuscript.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan

    Hiroyuki Ishida MD, Toshiro Ogura MD, PhD, Amane Takahashi MD, PhD, Ryoichi Miyamoto MD, PhD, Shinichi Matsudaira MD, PhD, Katsumi Amikura MD, PhD & Yoshiyuki Kawashima MD, PhD

  2. Department of Hepatobiliary and Pancreatic Surgery, Tokyo Medical and Dental University, Bunkyo ku, Tokyo, Japan

    Hiroyuki Ishida MD, Toshiro Ogura MD, PhD & Minoru Tanabe MD, PhD

Authors
  1. Hiroyuki Ishida MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Toshiro Ogura MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amane Takahashi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ryoichi Miyamoto MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shinichi Matsudaira MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Katsumi Amikura MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Minoru Tanabe MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yoshiyuki Kawashima MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception and design of the work: HI, TO; Data analysis and interpretation: HI, TO, AT, RM, SM, KA; Writing—original draft: HI; Writing—review and editing: TO, AT, KA; Supervision: MT, YK; All authors reviewed the results and approved the final version of the manuscript.

Corresponding author

Correspondence to Toshiro Ogura MD, PhD.

Ethics declarations

Disclosure

The authors declare that they have no conflicts of interest that are directly relevant to the content of this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ishida, H., Ogura, T., Takahashi, A. et al. Optimal Region of Lymph Node Dissection in Distal Pancreatectomy for Left-Sided Pancreatic Cancer Based on Tumor Location. Ann Surg Oncol 29, 2414–2424 (2022). https://doi.org/10.1245/s10434-021-11108-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-021-11108-5

Search

Navigation