Prognostic impact of para-aortic lymph node metastases in non-pancreatic periampullary cancer

Autor:	Benjamin Müssle, Sebastian Hempel, Hans-Detlev Saeger, Jürgen Weitz, Daniela Aust, Thilo Welsch, Marius Distler, Florian Oehme
Jazyk:	angličtina
Rok vydání:	2020
Předmět:	Male medicine.medical_specialty Para-aortic lymph node Survival lcsh:Surgery 030230 surgery lcsh:RC254-282 Pancreaticoduodenectomy Metastasis 03 medical and health sciences Pancreatectomy 0302 clinical medicine Duodenal Neoplasms Surgical oncology Pancreatic cancer Abdomen medicine Periampullary cancer Humans Stage (cooking) Non-pancreatic periampullary cancer Lymph node Aged Retrospective Studies Pancreatoduodenectomy business.industry Research lcsh:RD1-811 Middle Aged Prognosis medicine.disease lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens people.cause_of_death Confidence interval Para-aortic lymph nodes Survival Rate medicine.anatomical_structure Oncology Lymphatic Metastasis 030220 oncology & carcinogenesis Female Surgery Lymph Nodes Radiology people business
Zdroj:	World Journal of Surgical Oncology, Vol 18, Iss 1, Pp 1-9 (2020) World Journal of Surgical Oncology
ISSN:	1477-7819
Popis:	Background Resection of the para-aortic lymph node (PALN) group Ln16b1 during pancreatoduodenectomy remains controversial because PALN metastases are associated with a worse prognosis in pancreatic cancer patients. The present study aimed to analyze the impact of PALN metastases on outcome after non-pancreatic periampullary cancer resection. Methods One hundred sixty-four patients with non-pancreatic periampullary cancer who underwent curative pancreatoduodenectomy or total pancreatectomy between 2005 and 2016 were retrospectively investigated. The data were supplemented with a systematic literature review on this topic. Results In 67 cases, the PALNs were clearly assigned and could be histopathologically analyzed. In 10.4% of cases (7/67), tumor-infiltrated PALNs (PALN+) were found. Metastatic PALN+ stage was associated with increased tumor size (P = 0.03) and a positive nodal stage (P < 0.001). The median overall survival (OS) of patients with metastatic PALN and non-metastatic PALN (PALN–) was 24.8 and 29.5 months, respectively. There was no significant difference in the OS of PALN+ and pN1 PALN patients (P = 0.834). Patients who underwent palliative surgical treatment (n = 20) had a lower median OS of 13.6 (95% confidence interval 2.7–24.5) months. Including the systematic literature review, only 23 cases with PALN+ status and associated OS could be identified; the average survival was 19.8 months. Conclusion PALN metastasis reflects advanced tumor growth and lymph node spread; however, it did not limit overall survival in single-center series. The available evidence of the prognostic impact of PALN metastasis is scarce and a recommendation against resection in these cases cannot be given.
Databáze:	OpenAIRE
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