Sahakyan Mushegh A, Haugvik Sven P, Røsok Bård I, Kazaryan Airazat M, Ignjatovic Dejan, Buanes Trond, Labori Knut J, Verbeke Caroline S, Edwin Bjørn
The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
Department of Surgery, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway; Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
HPB (Oxford). 2018 Feb;20(2):175-181. doi: 10.1016/j.hpb.2017.08.038. Epub 2017 Sep 22.
Lymph node yield (LNY) is an indicator of oncological adequacy of surgery in patients with pancreatic ductal adenocarcinoma (PDAC). Our hypothesis is that standardized pathology examination (SPE) aimed at accurate staging can increase the LNY without changing surgical technique.
After the introduction of SPE for distal pancreatosplenectomy specimens at Oslo University Hospital, prospective data were collected on patients with PDAC undergoing laparoscopic distal pancreatosplenectomy (LDP). Their data were compared with retrospective data from specimens examined in a non-standardized way (NSPE).
SPE and NSPE were applied to 20 and 33 specimens, respectively. SPE was associated with a higher LNY and a higher median number of positive lymph nodes (PLN) in the specimen (18 vs 7, P = 0.001 and 4 vs 1, P = 0.005, respectively). In the stepwise regression model, SPE and younger age resulted in an increased LNY. In the logistic regression model, increased LNY and larger tumor size positively correlated with the presence of PLN.
SPE of distal pancreatosplenectomy specimens is associated with higher LNY in patients with PDAC, which increases the likelihood of detecting PLN and reduces the risk of understaging. These findings also indicate that the LDP technique provides an adequate LNY in patients with PDAC.
淋巴结收获量（LNY）是胰腺导管腺癌（PDAC）患者手术肿瘤学充分性的一个指标。我们的假设是，旨在准确分期的标准化病理检查（SPE）可在不改变手术技术的情况下增加LNY。
在奥斯陆大学医院对远端胰腺脾切除术标本引入SPE后，收集了接受腹腔镜远端胰腺脾切除术（LDP）的PDAC患者的前瞻性数据。将他们的数据与以非标准化方式（NSPE）检查的标本的回顾性数据进行比较。
SPE和NSPE分别应用于20个和33个标本。SPE与标本中更高的LNY和更高的阳性淋巴结（PLN）中位数相关（分别为18个对7个，P = 0.001；4个对1个，P = 0.005）。在逐步回归模型中，SPE和更年轻的年龄导致LNY增加。在逻辑回归模型中，LNY增加和肿瘤尺寸更大与PLN的存在呈正相关。
远端胰腺脾切除术标本的SPE与PDAC患者更高的LNY相关，这增加了检测到PLN的可能性并降低了分期不足的风险。这些发现还表明，LDP技术为PDAC患者提供了足够的LNY。
