Nomura Satoshi, Masui Toshihiko, Muto Jun, Hashida Kazuki, Kitagawa Hirohisa, Fujinuma Ibuki, Kitamura Kei, Ogura Toshiro, Takahashi Amane, Kawamoto Kazuyuki
Department of Surgery, Kurashiki Central Hospital, Kurashiki, Japan; Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan. Electronic address: https://www.twitter.com/NomuraSat60488.
Department of Surgery, Kurashiki Central Hospital, Kurashiki, Japan.
Surgery. 2025 Feb;178:108930. doi: 10.1016/j.surg.2024.10.021. Epub 2024 Nov 23.
The optimal resection for pancreatic neck cancer is challenging in clinical practice because we could dissect by pancreaticoduodenectomy or distal pancreatectomy. The purpose of this study was to evaluate the effectiveness of lymph node dissection and to help determine the optimal surgical treatment for pancreatic neck cancer.
We retrospectively evaluated 462 patients with pancreatic cancer who underwent curative-intent pancreatectomy between 2012 and 2022, 35 of whom had pancreatic neck cancer without preoperative radiologic gastroduodenal artery contact. We analyzed the clinicopathological characteristics, lymph node metastasis stations, and the efficacy index of lymph node dissection, which was calculated by multiplying the frequency of lymph node metastasis to each station by the 5-year survival rate of patients with positive lymph nodes at each station.
The lymph node station with the greatest rate of metastasis was #11p (28.6%), followed by #8 (17.1%), #14 (14.3%), #13 (14.3%), #17 (9.5%), and #6 (4.8%). The efficacy indices of lymph node dissection were 14.3 for #11, 4.76 for #13, and 8.57 for #14. There were no significant differences in 5-year recurrence-free survival and 5-year overall survival between patients undergoing pancreaticoduodenectomy and those undergoing distal pancreatectomy (23.7% vs 54.7%, P = .142; 29.9% vs 51.1%, P = .179, respectively). Univariate survival analysis showed that tumor size ≥2 cm was associated with poor prognosis (hazard ratio, 3.842, P = .009).
PD with #11p lymph node dissection is preferable to DP in terms of survival benefit for pancreatic neck cancer with lymph node metastasis.
在临床实践中，胰颈癌的最佳切除术具有挑战性，因为我们可以通过胰十二指肠切除术或远端胰腺切除术进行解剖。本研究的目的是评估淋巴结清扫的有效性，并帮助确定胰颈癌的最佳手术治疗方法。
我们回顾性评估了2012年至2022年间接受根治性胰切除术的462例胰腺癌患者，其中35例为胰颈癌，术前影像学检查未发现胃十二指肠动脉受侵。我们分析了临床病理特征、淋巴结转移部位以及淋巴结清扫的疗效指数，该指数通过将每个部位的淋巴结转移频率乘以该部位淋巴结阳性患者的5年生存率来计算。
转移率最高的淋巴结部位是#11p（28.6%），其次是#8（17.1%）、#14（14.3%）、#13（14.3%）、#17（9.5%）和#6（4.8%）。#11、#13和#14部位淋巴结清扫的疗效指数分别为14.3、4.76和8.57。接受胰十二指肠切除术和远端胰腺切除术的患者在5年无复发生存率和5年总生存率方面无显著差异（分别为23.7%对54.7%，P = 0.142；29.9%对51.1%，P = 0.179）。单因素生存分析显示，肿瘤大小≥2 cm与预后不良相关（风险比，3.842，P = 0.009）。
对于有淋巴结转移的胰颈癌，在生存获益方面，行#11p淋巴结清扫的胰十二指肠切除术优于远端胰腺切除术。
