Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
Ann Surg Oncol. 2021 Mar;28(3):1602-1611. doi: 10.1245/s10434-020-09066-5. Epub 2020 Aug 29.
A consensus regarding the optimal extent of lymph node dissection for pancreatic cancer has not yet been achieved. The purpose of this study was to evaluate the efficacy of lymph node dissection according to the location for pancreatic cancer.
A total of 495 patients diagnosed with invasive ductal carcinoma of the pancreas who had undergone a pancreatectomy between October 2002 and December 2015 were analyzed. The efficacy index (EI) was calculated for each lymph node station via multiplication of the frequency of metastasis to the station and the 5-year survival rate of the patients with metastasis to that station.
For pancreatic head (Ph) tumors, mesocolon lymph nodes had a high EI, although not regional. For pancreatic body (Pb) tumors, peri-Ph lymph nodes had a high EI, although not regional. For pancreatic tail (Pt) tumors, lymph nodes along the celiac axis and common hepatic artery had a zero EI, although regional. When the Ph was segmented into the pancreatic neck (Ph-neck), uncinate process (Ph-up), and periampullary regions, hepatoduodenal ligament lymph nodes had a zero EI for Ph-up, although regional; the mesojejunum lymph node also had a zero EI, even for Ph-up, regardless of a high incidence of metastasis. Regarding lymph node recurrence after surgery, recurrence was most frequently found at the peri-Ph lymph node (12%) in patients with Pb tumors who had undergone a distal pancreatectomy.
The optimal extent of lymph node dissection should be estimated in regard to the tumor location.
目前对于胰腺癌淋巴结清扫的最佳范围尚未达成共识。本研究旨在评估根据胰腺癌位置进行淋巴结清扫的疗效。
分析了 2002 年 10 月至 2015 年 12 月期间接受胰切除术的 495 例浸润性导管腺癌患者。通过将转移到该站的频率与转移到该站的患者的 5 年生存率相乘，计算每个淋巴结站的疗效指数（EI）。
对于胰头（Ph）肿瘤，结肠系膜淋巴结的 EI 较高，尽管不是区域性的。对于胰体（Pb）肿瘤，胰头周围淋巴结的 EI 较高，尽管不是区域性的。对于胰尾（Pt）肿瘤，沿腹腔干和肝总动脉的淋巴结的 EI 为零，尽管是区域性的。当 Ph 被分为胰颈（Ph-neck）、钩突（Ph-up）和壶腹周围区域时，肝十二指肠韧带淋巴结对于 Ph-up 的 EI 为零，尽管是区域性的；即使对于 Ph-up，空肠系膜淋巴结的 EI 也为零，尽管转移率较高。关于手术后淋巴结复发，接受胰体尾切除术的 Pb 肿瘤患者中，最常见的复发部位是胰头周围淋巴结（12%）。
应根据肿瘤位置评估淋巴结清扫的最佳范围。
