Petrova Ekaterina, Mazzella Elena, Trojan Jörg, Koch Christine, Schulze Falko, Bechstein Wolf O, Schnitzbauer Andreas A
Department of General, Visceral, Transplant, and Thoracic Surgery, Frankfurt University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
Department of General, Visceral, Transplant, and Thoracic Surgery, Frankfurt University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
Eur J Surg Oncol. 2023 May;49(5):996-1000. doi: 10.1016/j.ejso.2022.12.012. Epub 2022 Dec 23.
INTRODUCTION: The role of paraaortic lymphadenectomy for cancer of the pancreatic head is controversial. The aim of this study is to analyze the prognostic role of paraaortic lymph node (PALN) metastases after resection for ductal adenocarcinoma of the pancreatic head. MATERIALS AND METHODS: A retrospective analysis of all patients, who underwent upfront resection for ductal adenocarcinoma of the pancreatic head at the Frankfurt University Hospital from 2011 to 2020 was performed. The primary endpoint was survival, according to the presence of PALN metastases. RESULTS: Out of 468 patients with pancreatic resection, 148 had an upfront resection for ductal adenocarcinoma. Of those, in 125 (85%) a paraaortic lymphadenectomy was performed. In 19 (15.2%) PALN metastases were detected. The estimated overall median survival after resection was 21.7 months (95% CI 18.8 to 26.4), the disease free survival 16 months (95% CI 12 to 18). Among the patients with lymph node metastases, PALN metastases had no significant influence on overall (18.9 versus 19 months, HR = 1.3, 95% CI 0.7 to 2.6, p = 0.392) or disease free survival (14 versus 10.7 months, HR = 1.7, 95% CI 0.9 to 3.2, p = 0.076). After adjusting for T-stage, N-stage, grade, resection margin, PALN metastases, and adjuvant therapy, only adjuvant therapy had a prognostic significance for overall survival (HR = 0.47, 95% CI 0.26 to 0.85, p = 0.013). CONCLUSION: Patients with ductal adenocarcinoma of the pancreatic head and PALN metastases do not have inferior outcomes than those with regional lymph node metastases. Thus, positive PALN should not be considered a contraindication for resection.
引言：腹主动脉旁淋巴结清扫术在胰头癌治疗中的作用存在争议。本研究旨在分析胰头导管腺癌切除术后腹主动脉旁淋巴结（PALN）转移对预后的影响。 材料与方法：对2011年至2020年在法兰克福大学医院接受胰头导管腺癌初次切除的所有患者进行回顾性分析。主要终点是根据PALN转移情况的生存率。 结果：在468例行胰腺切除术的患者中，148例接受了胰头导管腺癌的初次切除。其中，125例（85%）进行了腹主动脉旁淋巴结清扫术。19例（15.2%）检测到PALN转移。切除术后估计的总中位生存期为21.7个月（95%CI 18.8至26.4），无病生存期为16个月（95%CI 12至18）。在有淋巴结转移的患者中，PALN转移对总生存期（18.9个月对19个月，HR = 1.3，95%CI 0.7至2.6，p = 0.392）或无病生存期（14个月对10.7个月，HR = 1.7，95%CI 0.9至3.2，p = 0.076）均无显著影响。在调整了T分期、N分期、分级、切缘、PALN转移和辅助治疗后，只有辅助治疗对总生存期具有预后意义（HR = 0.47，95%CI 0.26至0.85，p = 0.013）。 结论：胰头导管腺癌伴PALN转移的患者预后并不比区域淋巴结转移患者差。因此，PALN阳性不应被视为切除的禁忌证。
World J Gastrointest Surg. 2022-5-27
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