Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka 540-0006, Japan.
Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka 540-0006, Japan.
Hepatobiliary Pancreat Dis Int. 2018 Feb;17(1):75-80. doi: 10.1016/j.hbpd.2018.01.004.
In general, para-aortic lymph node (LN16) metastasis has been considered as a contraindication for pancreatic resection. However, some pancreatic cancer patients with LN16 metastasis have been reported to survive for longer than expected after pancreatectomy. The purpose of this study was to determine whether pancreatic cancer patients with LN16 metastasis might benefit from surgery.
We retrospectively reviewed 201 consecutive patients with invasive pancreatic ductal adenocarcinoma who underwent surgery at Osaka National Hospital between April 2003 and December 2012. These patients included 22 patients with LN16 metastasis who underwent an extended lymphadenectomy and 25 patients who underwent a palliative surgical biliary and gastric bypass. The clinicopathological data and outcomes were evaluated using univariate and multivariate analyses.
The overall survival of the patients with LN16 metastasis was poorer than that of the LN16-negative patients (P = 0.0014). An overall survival analysis of the LN16-positive patients stratified according to the preoperative CA19-9 level showed a significant difference between patients with a low preoperative CA19-9 level (≤360 U/mL) and those with a high preoperative CA19-9 level (>360 U/mL) (P = 0.0301). No significant difference in overall survival of patients was observed between those with LN16 positivity and those who underwent bypass surgery. However, the overall survival of the LN16-positive patients with a CA19-9 level ≤360 U/mL (n = 11) was significantly higher than that of those who underwent bypass surgery (P = 0.0452).
Surgical resection and extended lymphadenectomy remains an option for pancreatic cancer patients with LN16-positivity whose CA19-9 level is ≤360 U/mL.
一般来说，腹主动脉旁淋巴结（LN16）转移被认为是胰腺切除术的禁忌证。然而，一些 LN16 转移的胰腺癌患者在接受胰腺切除术后的存活时间比预期的要长。本研究旨在确定 LN16 转移的胰腺癌患者是否可能从手术中获益。
我们回顾性分析了 201 例在大阪国立医院接受手术治疗的浸润性胰腺导管腺癌患者，这些患者的手术时间为 2003 年 4 月至 2012 年 12 月。这些患者包括 22 例接受扩大淋巴结清扫术的 LN16 转移患者和 25 例接受姑息性胆道和胃旁路手术的患者。使用单因素和多因素分析评估临床病理数据和结果。
LN16 转移患者的总体生存率差于 LN16 阴性患者（P=0.0014）。对 LN16 阳性患者进行术前 CA19-9 水平分层的总体生存分析显示，术前 CA19-9 水平较低（≤360U/mL）和较高（>360U/mL）的患者之间存在显著差异（P=0.0301）。在 LN16 阳性患者中，接受旁路手术的患者与未接受旁路手术的患者的总体生存率无显著差异。然而，CA19-9 水平≤360U/mL（n=11）的 LN16 阳性患者的总体生存率明显高于接受旁路手术的患者（P=0.0452）。
对于 CA19-9 水平≤360U/mL 的 LN16 阳性胰腺癌患者，手术切除和扩大淋巴结清扫仍然是一种选择。
