Practical significance of pancreatectomy with lymphadenectomy around the superior mesenteric artery for pancreatic cancer: comparison of prognosis after adjusting for major prognostic factors.
Lymphadenectomy
Pancreatic cancer
Pancreaticoduodenectomy
Superior mesenteric artery
Journal
Langenbeck's archives of surgery
ISSN: 1435-2451
Titre abrégé: Langenbecks Arch Surg
Pays: Germany
ID NLM: 9808285
Informations de publication
Date de publication:
May 2021
May 2021
Historique:
received:
09
10
2020
accepted:
31
03
2021
pubmed:
9
4
2021
medline:
25
9
2021
entrez:
8
4
2021
Statut:
ppublish
Résumé
Although pancreatectomy with lymph node (LN) and nerve plexus dissection has usually been performed for pancreatic cancer, recent randomized controlled trials have questioned its survival benefits. However, superior mesenteric artery (SMA) LN dissection has still been included in standard treatment guidelines. A total of 94 patients who underwent pancreaticoduodenectomy for resectable pancreatic cancer without LN enlargement around the SMA on imaging were identified between 2008 and 2017. Disease-free survival (DFS), overall survival (OS), and complications were compared between those with LN and hemicircumferential nerve plexus dissection around the SMA (SMA ly+) and those without thorough LN and nerve plexus dissection around the SMA (SMA ly-) after adjusting for major prognostic factors. A total of 78 and 16 patients with SMA ly+ and SMA ly- were identified, respectively. Our data demonstrated no difference in DFS and OS rates between both groups (P = 0.18 and 0.83, respectively). Patients with SMA ly+ had significantly more complications, particularly severe diarrhea, compared to those with SMA ly- (P = 0.001). LN and nerve plexus dissection around the SMA did not prolong survival and significantly increased the frequency of severe diarrhea, suggesting that performing in all cases carries less practical significance.
Identifiants
pubmed: 33830337
doi: 10.1007/s00423-021-02166-0
pii: 10.1007/s00423-021-02166-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
703-711Commentaires et corrections
Type : ErratumIn
Références
Siegel RL, Miller KD, Jemal A (2019) Cancer statistics, 2019. CA Cancer J Clin 69:7–34. https://doi.org/10.3322/caac.21551
doi: 10.3322/caac.21551
Cancer statistics in Japan ’18 Cancer information Service, National Cancer Center Japan (2019). https://ganjoho.jp/en/professional/statistics/brochure/2018_en.html . Accessed 26 September 2020
National Cancer Institute (2017) Cancer of the Pancreas - SEER Stat Fact Sheets. Surveillance, Epidemiol. End Results Progr. http://seer.cancer.gov/statfacts/html/pancreas.html . Accessed 26 September 2020
Conroy T, Desseigne F, Ychou M, Bouche O, Guimbaud R, Becouarn Y et al (2011) Folfirinox versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 365:768–769. https://doi.org/10.1056/nejmoa1011923
doi: 10.1056/nejmoa1011923
Von Hoff DD, Ervin T, Arena FP, Chiorean EG, Infante J, Moore M et al (2013) Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med 369:1691–1703. https://doi.org/10.1056/nejmoa1304369
doi: 10.1056/nejmoa1304369
Manabe T, Ohshio G, Baba N, Miyashita T, Asano N, Tamura K, Yamaki K, Nonaka A, Tobe T (1989) Radical pancreatectomy for ductal cell carcinoma of the head of the pancreas. Cancer. 64:1132–1137. https://doi.org/10.1002/1097-0142(19890901)64:5<1132::AID-CNCR2820640528>3.0.CO;2-V
doi: 10.1002/1097-0142(19890901)64:5<1132::AID-CNCR2820640528>3.0.CO;2-V
pubmed: 2547508
Nagakawa T, Nagamori M, Futakami F, Tsukioka Y, Kayahara M, Ohta T, Ueno K, Miyazaki I (1996) Results of extensive surgery for pancreatic carcinoma. Cancer. 77:640–645. https://doi.org/10.1002/(SICI)1097-0142(19960215)77:4<640::AID-CNCR9>3.0.CO;2-K
doi: 10.1002/(SICI)1097-0142(19960215)77:4<640::AID-CNCR9>3.0.CO;2-K
pubmed: 8616755
Yeo CJ, Cameron JL, Lillemoe KD, Sohn TA, Campbell KA, Sauter PK, Coleman JA, Abrams RA, Hruban RH (2002) Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, Part 2. Ann Surg 236:355–368. https://doi.org/10.1097/00000658-200209000-00012
doi: 10.1097/00000658-200209000-00012
pubmed: 12192322
pmcid: 1422589
Farnell MB, Pearson RK, Sarr MG, DiMagno EP, Burgart LJ, Dahl TR et al (2005) A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery. 138:618–628. https://doi.org/10.1016/j.surg.2005.06.044
doi: 10.1016/j.surg.2005.06.044
pubmed: 16269290
Nimura Y, Nagino M, Takao S, Takada T, Miyazaki K, Kawarada Y, Miyagawa S, Yamaguchi A, Ishiyama S, Takeda Y, Sakoda K, Kinoshita T, Yasui K, Shimada H, Katoh H (2012) Standard versus extended lymphadenectomy in radical pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas. J Hepatobiliary Pancreat Sci 19:230–241. https://doi.org/10.1007/s00534-011-0466-6
doi: 10.1007/s00534-011-0466-6
pubmed: 22038501
Jang J-Y, Kang MJ, Heo JS, Choi SH, Choi DW, Park SJ, Han SS, Yoon DS, Yu HC, Kang KJ, Kim SG, Kim SW (2014) 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 259:656–664. https://doi.org/10.1097/sla.0000000000000384
doi: 10.1097/sla.0000000000000384
pubmed: 24368638
Jang J-Y, Kang JS, Han Y, Heo JS, Choi SH, Choi DW, Park SJ, Han SS, Yoon DS, Park JS, Yu HC, Kang KJ, Kim SG, Lee H, Kwon W, Yoon YS, Han HS, Kim SW (2017) Long-term outcomes and recurrence patterns of standard versus extended pancreatectomy for pancreatic head cancer: a multicenter prospective randomized controlled study. J Hepatobiliary Pancreat Sci 24:426–433. https://doi.org/10.1002/jhbp.465
doi: 10.1002/jhbp.465
pubmed: 28514000
Okusaka T, Nakamura M, Shimizu K, Furuse J, Ito Y, Hanada K et al (2020) Clinical practice guidelines for pancreatic cancer 2019 from the Japan Pancreas Society: a synopsis. Pancreas. 49:326–335. https://doi.org/10.1097/mpa.0000000000001513
doi: 10.1097/mpa.0000000000001513
pubmed: 32132516
Oettle H, Neuhaus P, Hochhaus A, Hartmann JT, Gellert K, Ridwelski K, Niedergethmann M, Zülke C, Fahlke J, Arning MB, Sinn M, Hinke A, Riess H (2013) Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. J Am Med Assoc 310:1473–1481. https://doi.org/10.1001/jama.2013.279201
doi: 10.1001/jama.2013.279201
Ueno H, Kosuge T, Matsuyama Y, Yamamoto J, Nakao A, Egawa S, Doi R, Monden M, Hatori T, Tanaka M, Shimada M, Kanemitsu K (2009) A randomised phase III trial comparing gemcitabine with surgery-only in patients with resected pancreatic cancer: Japanese Study Group of Adjuvant Therapy for Pancreatic Cancer. Br J Cancer 101:908–915. https://doi.org/10.1038/sj.bjc.6605256
doi: 10.1038/sj.bjc.6605256
pubmed: 19690548
pmcid: 2743365
Uesaka K, Boku N, Fukutomi A, Okamura Y, Konishi M, Matsumoto I, Kaneoka Y, Shimizu Y, Nakamori S, Sakamoto H, Morinaga S, Kainuma O, Imai K, Sata N, Hishinuma S, Ojima H, Yamaguchi R, Hirano S, Sudo T, Ohashi Y (2016) Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer: a phase 3, open-label, randomised, non-inferiority trial (JASPAC 01). Lancet. 388:248–257. https://doi.org/10.1016/s0140-6736(16)30583-9
doi: 10.1016/s0140-6736(16)30583-9
pubmed: 27265347
Valle JW, Palmer D, Jackson R, Cox T, Neoptolemos JP, Ghaneh P, Rawcliffe CL, Bassi C, Stocken DD, Cunningham D, O'Reilly D, Goldstein D, Robinson BA, Karapetis C, Scarfe A, Lacaine F, Sand J, Izbicki JR, Mayerle J, Dervenis C, Oláh A, Butturini G, Lind PA, Middleton MR, Anthoney A, Sumpter K, Carter R, Büchler MW (2014) Optimal duration and timing of adjuvant chemotherapy after definitive surgery for ductal adenocarcinoma of the pancreas: Ongoing lessons from the ESPAC-3 study. J Clin Oncol 32:504–512. https://doi.org/10.1200/jco.2013.50.7657
doi: 10.1200/jco.2013.50.7657
pubmed: 24419109
Merkow RP, Bilimoria KY, Tomlinson JS, Paruch JL, Fleming JB, Talamonti MS, Ko CY, Bentrem DJ (2014) Postoperative complications reduce adjuvant chemotherapy use in resectable pancreatic cancer. Ann Surg 260:372–377. https://doi.org/10.1097/sla.0000000000000378
doi: 10.1097/sla.0000000000000378
pubmed: 24374509
Japan Pancreas Society (2011) Classification of Pancreatic Carcinoma, Third English edn. Kanehara & Co., Ltd, Tokyo
Rochefort MM, Ankeny JS, Kadera BE, Donald GW, Isacoff W, Wainberg ZA, Hines OJ, Donahue TR, Reber HA, Tomlinson JS (2013) Impact of tumor grade on pancreatic cancer prognosis: validation of a novel TNMG staging system. Ann Surg Oncol 20:4322–4329. https://doi.org/10.1245/s10434-013-3159-3
doi: 10.1245/s10434-013-3159-3
pubmed: 23943022
Hlavsa J, Cecka F, Zaruba P, Zajak J, Gurlich R, Strnad R et al (2018) Tumor grade as significant prognostic factor in pancreatic cancer: validation of a novel TNMG staging system. Neoplasma. 65:637–643. https://doi.org/10.4149/neo_2018_171012n650
doi: 10.4149/neo_2018_171012n650
pubmed: 30064236
Kato K, Yamada S, Sugimoto H, Kanazumi N, Nomoto S, Takeda S, Kodera Y, Morita S, Nakao A (2009) Prognostic factors for survival after extended pancreatectomy for pancreatic head cancer: influence of resection margin status on survival. Pancreas. 38:605–612. https://doi.org/10.1097/mpa.0b013e3181a4891d
doi: 10.1097/mpa.0b013e3181a4891d
pubmed: 19629002
Mayo SC, Austin DF, Sheppard BC, Mori M, Shipley DK, Billingsley KG (2010) Adjuvant therapy and survival after resection of pancreatic adenocarcinoma. Cancer. 116:2932–2940. https://doi.org/10.1002/cncr.25082
doi: 10.1002/cncr.25082
pubmed: 20336787
Croome KP, Farnell MB, Que FG, Reid-Lombardo KM, Truty MJ, Nagorney DM, Kendrick ML (2014) Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg 260:633–638; discussion 638–40. https://doi.org/10.1097/sla.0000000000000937
doi: 10.1097/sla.0000000000000937
pubmed: 25203880
Watanabe J, Otani S, Sakamoto T, Arai Y, Hanaki T, Amisaki M, Tokuyasu N, Honjo S, Ikeguchi M (2016) Prognostic indicators based on inflammatory and nutritional factors after pancreaticoduodenectomy for pancreatic cancer. Surg Today 46:1258–1267. https://doi.org/10.1007/s00595-016-1308-6
doi: 10.1007/s00595-016-1308-6
pubmed: 26869184
Inoue Y, Saiura A, Oba A, Kawakatsu S, Ono Y, Sato T, Mise Y, Ishizawa T, Takahashi Y, Ito H (2019) Optimal extent of superior mesenteric artery dissection during pancreaticoduodenectomy for pancreatic cancer: balancing surgical and oncological safety. J Gastrointest Surg 23:1373–1383. https://doi.org/10.1007/s11605-018-3995-3
doi: 10.1007/s11605-018-3995-3
pubmed: 30306451