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- Title
Prognostic impact of para-aortic lymph node metastases in non-pancreatic periampullary cancer.
- Authors
Hempel, Sebastian; Oehme, Florian; Müssle, Benjamin; Aust, Daniela E.; Distler, Marius; Saeger, Hans-Detlev; Weitz, Jürgen; Welsch, Thilo
- 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.
- Subjects
LYMPH nodes; METASTASIS; LYMPHATIC metastasis; ONCOLOGIC surgery; PANCREATICODUODENECTOMY; TUMOR growth
- Publication
World Journal of Surgical Oncology, 2020, Vol 18, Issue 1, p1
- ISSN
1477-7819
- Publication type
Article
- DOI
10.1186/s12957-020-1783-5