Efficacy of Extended Lymphadenectomy in Radical Pancreatoduodenectomy for Pancreatic Head Carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 YANGMing , WUHe-shui , XIONGJiong-xin , ZHAOGang , ZHOUFeng , TAOJing , YANGZhi-yong , YINTao ,  WANGChun-you

Deparment of Pancreatic Surgery, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China;

Corresponding author：

WANGChun-you, Email: chunyouwang52@126.com

Keywords：

Pancreatic cancer; Pancreatoduodenectomy; Extended lymphadenectomy

DOI：

10.7507/1007-9424.20140192

Video：

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Objective To investigate the indications and clinical effect of pancreatoduodenectomy with extended lymphadenectomy for pancreatic head carcinoma. Methods The clinical data of 21 patients with pancreatic head carcinoma that performed pancreatoduodenectomy with extended lymphadenectomy between June 2010 to June 2011 in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology were retrospective analyzed. The 21 patients included 15 men and 6 women with an age range of 36-57 years and an average age of 47.8 years. Results There were 3 cases(14.3%), 9 cases(42.9%), 8 cases(38.1%), and 1 case(4.8%) in stageⅠ, ⅡA, ⅡB, andⅢ, respectively. Eighteen cases had a R0 resection(85.7%) and 3 cases had a R1 resection. The total number of resected lymph nodes were 14-43 with an average of 27.4. Lymph node invasion occurred in 10 cases(47.6%). The average operative time was 6.8 h(5-8.5 h) and the average amount of blood transfusion was 5.6 U(3-8 U). There was no death in this group and 5 cases(23.8%) had postoperative complications. Tree cases(14.3%) developed pancreatic fistula, 1 case(4.8%) developed bile leakage, 1 case(4.8%) developed abdominal hemorrhage, 1 case(4.8%) developed gastrointestinal bleeding, and 2 cases(9.5%) developed intractable diarrhea. Postoperative pathological results in high, medium, and low differentiated adenocarcinoma was 6 cases(28.6%), 10 cases(47.6%), and 5 cases(23.8%), respec-tively. Twenty one cases were followed-up, the follow-up time ranged from 5 to 40 months with a median time of 19 months. 1-, 2-, and 3-year cumulative survival rates was 66.7%, 38.1%, and 19%, respectively. Conclusion Selective application of pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head carcinoma is conducive to increase the proportion of the radical resection and improve the prognosis, but the postoperative complications is higher.

Citation： YANGMing, WUHe-shui, XIONGJiong-xin, ZHAOGang, ZHOUFeng, TAOJing, YANGZhi-yong, YINTao, WANGChun-you. Efficacy of Extended Lymphadenectomy in Radical Pancreatoduodenectomy for Pancreatic Head Carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(7): 798-801. doi: 10.7507/1007-9424.20140192 Copy

1.	Fortner JG, Kim DK, Cubilla A, et al. Regional pancreatectomy: en bloc pancreatic, portal vein and lymph node resection[J]. Ann Surg, 1977, 186(1):42-50.
2.	Fortner JG. Regional resection of cancer of the pancreas:a new surgical approach[J]. Surgery, 1973, 73(2):307-320.
3.	Ishikawa O, Ohhigashi H, Sasaki Y, et al. Practical usefulness of lymphatic and connective tissue clearance for the carcinoma of the pancreas head[J]. Ann Surg, 1988, 208(2):215-220.
4.	Manabe T, Ohshio G, Baba N, et al. Radical pancreatectomy for ductal cell carcinoma of the head of the pancreas[J]. Cancer, 1989, 64(5):1132-1137.
5.	Sindelar WF. Clinical experience with regional pancreatectomy for adenocarcinoma of the pancreas[J]. Arch Surg, 1989, 124(1):127-132.
6.	Satake K, Nishiwaki H, Yokomatsu H, et al. Surgical curability and prognosis for standard versus extended resection for T1 carcinoma of the pancreas[J]. Surg Gynecol Obstet, 1992, 175(3): 259-265.
7.	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[J]. Surgery, 2005, 138(4): 618-630.
8.	Nagakawa T, Nagamori M, Futakami F, et al. Results of extensive surgery for pancreatic carcinoma[J]. Cancer, 1996, 77(4): 640-645.
9.	Hirata K, Sato T, Mukaiya M, et al. Results of 1001 pancreatic resections for invasive ductal adenocarcinoma of the pancreas[J]. Arch Surg, 1997, 132(7):771-777.
10.	Pedrazzoli S, DiCarlo V, Dionigi R, et al. Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas:a multicenter, prospective, randomized study. Lymphadenectomy Study Group[J]. Ann Surg, 1998, 228(4):508-517.
11.	Fujii T. Extended lymphadenectomy in pancreatic cancer is crucial[J]. World J Surg, 2013, 37(8):1778-1781.
12.	Edge SB, Byrd DR, Compton CC, et al. American Joint Committee on Cancer:AJCC Cancer Staging Manual[M]. 7 ed. New York:Springer, 2010:24-1.
13.	NCCN. NCCN胰腺癌临床实践指南(中国版)[S]. 1 ed. 2011: PANC-B.
14.	Konstantinidis IT, Warshaw AL, Allen JN, et al. Pancreatic ductal adenocarcinoma:is there a survival difference for R1 resections versus locally advanced unresectable tumors? What is a "true" R0 resection?[J]. Ann Surg, 2013, 257(4):731-736.
15.	Nimura Y, Nagino M, Takao S, et al. Standard versus extended lymphadenectomy in radical pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas:long-term results of a Japanese multicenter randomized controlled trial[J]. J Hepatobiliary Pancreat Sci, 2012, 19(3):230-241.
16.	Murakami Y, Uemura K, Sudo T, et al. Prognostic impact of para-aortic lymph node metastasis in pancreatic ductal adenocarcinoma[J]. World J Surg, 2010, 34(8):1900-1907.
17.	Kanda M, Fujii T, Nagai S, et al. Pattern of lymph node metastasis spread in pancreatic cancer[J]. Pancreas, 2011, 40(6): 951-955.
18.	苗毅, 戴存才, 褚朝顺, 等.胰十二指肠切除术中肝门淋巴结清扫应注意的问题[J].外科理论与实践, 2005, 10(3):262-263.
19.	郑树国, 曾永毅.胰周淋巴结和神经丛的解剖学分类与胰头癌扩大切除术[J].中华消化外科杂志, 2007, 6(2):142-146.
20.	Riediger H, Keck T, Wellner U, et al. The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer[J]. J Gastrointest Surg, 2009, 13(7):1337-1344.
21.	Valsangkar NP, Bush DM, Michaelson JS, et al. N0/N1, PNL, or LNR? The effect of lymph node number on accurate survival prediction in pancreatic ductal adenocarcinoma[J]. J Gastrointest Surg, 2013, 17(2):257-266.
22.	Slidell MB, Chang DC, Cameron JL, et al. Impact of total lymph node count and lymph node ratio on staging and survival after pancreatectomy for pancreatic adenocarcinoma:a large, population-based analysis[J]. Ann Surg Oncol, 2008, 15(1): 165-174.
23.	钟守先, 赵玉沛.论胰头癌根治术[J].中华外科杂志, 2005, 43(3):137-139.
24.	Hartwig W, Hackert T, Hinz U, et al. Pancreatic cancer surgery in the new millennium:better prediction of outcome[J]. Ann Surg, 2011, 254(2):311-319.
25.	Gillen S, Schuster T, Meyer Zum Buschenfelde C, et al. Preoperative/neoadjuvant therapy in pancreatic cancer:a systematic review and meta-analysis of response and resection percentages[J]. PLoS Med, 2010, 7(4):e1000267.
26.	Neoptolemos JP, Stocken DD, Friess H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer[J]. N Engl J Med, 2004, 350(12):1200-1210.

1. Fortner JG, Kim DK, Cubilla A, et al. Regional pancreatectomy: en bloc pancreatic, portal vein and lymph node resection[J]. Ann Surg, 1977, 186(1):42-50.
2. Fortner JG. Regional resection of cancer of the pancreas:a new surgical approach[J]. Surgery, 1973, 73(2):307-320.
3. Ishikawa O, Ohhigashi H, Sasaki Y, et al. Practical usefulness of lymphatic and connective tissue clearance for the carcinoma of the pancreas head[J]. Ann Surg, 1988, 208(2):215-220.
4. Manabe T, Ohshio G, Baba N, et al. Radical pancreatectomy for ductal cell carcinoma of the head of the pancreas[J]. Cancer, 1989, 64(5):1132-1137.
5. Sindelar WF. Clinical experience with regional pancreatectomy for adenocarcinoma of the pancreas[J]. Arch Surg, 1989, 124(1):127-132.
6. Satake K, Nishiwaki H, Yokomatsu H, et al. Surgical curability and prognosis for standard versus extended resection for T1 carcinoma of the pancreas[J]. Surg Gynecol Obstet, 1992, 175(3): 259-265.
7. 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[J]. Surgery, 2005, 138(4): 618-630.
8. Nagakawa T, Nagamori M, Futakami F, et al. Results of extensive surgery for pancreatic carcinoma[J]. Cancer, 1996, 77(4): 640-645.
9. Hirata K, Sato T, Mukaiya M, et al. Results of 1001 pancreatic resections for invasive ductal adenocarcinoma of the pancreas[J]. Arch Surg, 1997, 132(7):771-777.
10. Pedrazzoli S, DiCarlo V, Dionigi R, et al. Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas:a multicenter, prospective, randomized study. Lymphadenectomy Study Group[J]. Ann Surg, 1998, 228(4):508-517.
11. Fujii T. Extended lymphadenectomy in pancreatic cancer is crucial[J]. World J Surg, 2013, 37(8):1778-1781.
12. Edge SB, Byrd DR, Compton CC, et al. American Joint Committee on Cancer:AJCC Cancer Staging Manual[M]. 7 ed. New York:Springer, 2010:24-1.
13. NCCN. NCCN胰腺癌临床实践指南(中国版)[S]. 1 ed. 2011: PANC-B.
14. Konstantinidis IT, Warshaw AL, Allen JN, et al. Pancreatic ductal adenocarcinoma:is there a survival difference for R1 resections versus locally advanced unresectable tumors? What is a "true" R0 resection?[J]. Ann Surg, 2013, 257(4):731-736.
15. Nimura Y, Nagino M, Takao S, et al. Standard versus extended lymphadenectomy in radical pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas:long-term results of a Japanese multicenter randomized controlled trial[J]. J Hepatobiliary Pancreat Sci, 2012, 19(3):230-241.
16. Murakami Y, Uemura K, Sudo T, et al. Prognostic impact of para-aortic lymph node metastasis in pancreatic ductal adenocarcinoma[J]. World J Surg, 2010, 34(8):1900-1907.
17. Kanda M, Fujii T, Nagai S, et al. Pattern of lymph node metastasis spread in pancreatic cancer[J]. Pancreas, 2011, 40(6): 951-955.
18. 苗毅, 戴存才, 褚朝顺, 等.胰十二指肠切除术中肝门淋巴结清扫应注意的问题[J].外科理论与实践, 2005, 10(3):262-263.
19. 郑树国, 曾永毅.胰周淋巴结和神经丛的解剖学分类与胰头癌扩大切除术[J].中华消化外科杂志, 2007, 6(2):142-146.
20. Riediger H, Keck T, Wellner U, et al. The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer[J]. J Gastrointest Surg, 2009, 13(7):1337-1344.
21. Valsangkar NP, Bush DM, Michaelson JS, et al. N0/N1, PNL, or LNR? The effect of lymph node number on accurate survival prediction in pancreatic ductal adenocarcinoma[J]. J Gastrointest Surg, 2013, 17(2):257-266.
22. Slidell MB, Chang DC, Cameron JL, et al. Impact of total lymph node count and lymph node ratio on staging and survival after pancreatectomy for pancreatic adenocarcinoma:a large, population-based analysis[J]. Ann Surg Oncol, 2008, 15(1): 165-174.
23. 钟守先, 赵玉沛.论胰头癌根治术[J].中华外科杂志, 2005, 43(3):137-139.
24. Hartwig W, Hackert T, Hinz U, et al. Pancreatic cancer surgery in the new millennium:better prediction of outcome[J]. Ann Surg, 2011, 254(2):311-319.
25. Gillen S, Schuster T, Meyer Zum Buschenfelde C, et al. Preoperative/neoadjuvant therapy in pancreatic cancer:a systematic review and meta-analysis of response and resection percentages[J]. PLoS Med, 2010, 7(4):e1000267.
26. Neoptolemos JP, Stocken DD, Friess H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer[J]. N Engl J Med, 2004, 350(12):1200-1210.

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Efficacy of Extended Lymphadenectomy in Radical Pancreatoduodenectomy for Pancreatic Head Carcinoma

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