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

Abstract

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.

• Authors: Sebastian Hempel, Florian Oehme, Benjamin Müssle, Daniela E Aust, Marius Distler, Hans-Detlev Saeger, Jürgen Weitz, Thilo Welsch
• Journal: World journal of surgical oncology (World J Surg Oncol) Vol. 18 Issue 1 Pg. 16 (Jan 21 2020) ISSN: 1477-7819 [Electronic] England
• PMID: 31964383 (Publication Type: Journal Article, Systematic Review)

Topics

• Abdomen
• Aged
• Duodenal Neoplasms (mortality, pathology, surgery)
• Female
• Humans
• Lymph Nodes (pathology)
• Lymphatic Metastasis
• Male
• Middle Aged
• Pancreatectomy
• Pancreaticoduodenectomy
• Prognosis
• Retrospective Studies
• Survival Rate