Division of Gastrointestinal and HPB Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India.
Department of Biostatistics, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India.
Ann Surg Oncol. 2024 Oct;31(10):7052-7063. doi: 10.1245/s10434-024-15847-z. Epub 2024 Jul 20.
Surgery remains debatable in para-aortic lymph node (PALN, station 16b1) metastasis in non-pancreatic periampullary cancer (NPPAC). This study examined the impact of PALN metastasis on outcomes following pancreaticoduodenectomy (PD) in NPPAC.
A retrospective analysis of patients with NPPAC who were explored for PD with PALN dissection was performed. Based on the extent of nodal involvement on final histopathology, they were stratified as node-negative (N0), regional node involved (N+) and metastatic PALN (N16+) and their outcomes were compared.
Between 2011 and 2022, 153/887 PD patients underwent a PALN dissection, revealing N16+ in 42 patients (27.4%), of whom 32 patients underwent resection. The 3-years overall survival (OS) for patients with N16+ was 28% (95% confidence interval [CI] 13-60%), notably lower than the 67% (95% CI 53-83.5%; p = 0.007) for those without PALN metastasis. Stratified by nodal involvement, the median OS for N+ and N16+ patients was similar (28.4 months and 26.2 months, respectively). The N0 subgroup had a significantly longer 3-years OS of 87.5% (95% CI 79-96.7%; p = 0.0051). Interestingly, 10 patients not offered resection following N16+ identified on frozen section had a median survival of only 9 months. The perioperative morbidity and mortality in patients undergoing PD with PALN dissection were similar to standard resections.
In a select group of patients with NPPAC, PD in isolated PALN metastasis was associated with improved OS. The survival in this group of patients was comparable with regional node-positive patients and significantly better than palliative treatment alone.
在非胰腺壶腹周围癌（NPPAC）中，手术在腹主动脉旁淋巴结（PALN，站 16b1）转移中仍存在争议。本研究探讨了 PALN 转移对 NPPAC 患者行胰十二指肠切除术（PD）后结局的影响。
对接受 PD 并进行 PALN 解剖的 NPPAC 患者进行回顾性分析。根据最终病理检查中淋巴结受累的程度，将患者分为淋巴结阴性（N0）、区域淋巴结受累（N+）和转移性 PALN（N16+），并比较其结局。
2011 年至 2022 年，887 例行 PD 的患者中有 153 例行 PALN 解剖，其中 42 例（27.4%）发现 N16+，其中 32 例行切除术。N16+患者的 3 年总生存率（OS）为 28%（95%CI 13-60%），显著低于无 PALN 转移患者的 67%（95%CI 53-83.5%；p=0.007）。按淋巴结受累程度分层，N+和 N16+患者的中位 OS 相似（分别为 28.4 个月和 26.2 个月）。N0 亚组的 3 年 OS 显著更长，为 87.5%（95%CI 79-96.7%；p=0.0051）。有趣的是，10 例在冷冻切片上发现 N16+但未行切除术的患者中位生存期仅为 9 个月。行 PD 加 PALN 解剖的患者的围手术期发病率和死亡率与标准切除术相似。
在一组选择性的 NPPAC 患者中，孤立性 PALN 转移的 PD 与改善的 OS 相关。该组患者的生存率与区域淋巴结阳性患者相当，明显优于单纯姑息治疗。
