Prognostic Significance of Lymph Node Metastasis and Micrometastasis Along the Left Side of Superior Mesenteric Artery in Pancreatic Head Cancer

  • Kenjiro OkadaEmail author
  • Yoshiaki Murakami
  • Naru Kondo
  • Kenichiro Uemura
  • Naoya Nakagawa
  • Shingo Seo
  • Shinya Takahashi
  • Taijiro Sueda
2018 SSAT Quick Shot Presentation


Backgrounds and Objectives

Although metastasis in lymph nodes along the left side of superior mesenteric artery (SMA-LNs-lt) is sometimes found, survival benefit of SMA-LN-lt dissection for pancreatic head cancer is still unclear. The purpose of this study is to evaluate the prognostic significance of SMA-LN-lt metastasis and micrometastasis.


A total of 166 patients with pancreatic head cancer who underwent pancreatectomy with lymphadenectomy including SMA-LNs-lt between 2002 and 2017 were reviewed retrospectively. Micrometastasis was evaluated by immunohistochemistry.


Twenty patients (12%) had SMA-LN-lt metastasis detected by hematoxylin and eosin (HE) staining, and eight patients (5%) had micrometastasis. Patients with SMA-LN-lt HE-positive or micrometastasis group experienced significantly shorter overall survival (OS) than those without (p = .015). In multivariate analysis, SMA-LN-lt HE-positive or micrometastasis (p = .034), portal vein resection (p = .002), histologic grade 2/3 (p = .046), LN metastasis (p = .002), and lack of adjuvant chemotherapy (p < .001) were independent risk factors. Within a subset of SMA-LN-lt HE-positive or micrometastasis group, lack of adjuvant chemotherapy (p = .003) was the independent poor prognostic factor.


In pancreatic head cancer, the rate of SMA-LN-lt HE-positive and micrometastasis was found in 12% and 5%, respectively. Adjuvant chemotherapy may contribute to improvement of prognosis in patients with LN metastasis including SMA-LN-lt metastasis and micrometastasis.


Pancreatic head cancer Superior mesenteric artery Lymph node metastasis Micrometastasis Adjuvant chemotherapy 


Authors’ Contributions

Study concepts: Kenjiro Okada, Yoshiaki Murakami, Naru Kondo, Kenichiro Uemura, Naoya Nakagawa, Shingo Seo, Shinya Takahashi, and Taijiro Sueda.

Study design: Kenjiro Okada, Yoshiaki Murakami, Naru Kondo, Kenichiro Uemura, Naoya Nakagawa.

Data acquisition: Kenjiro Okada, Yoshiaki Murakami, Naru Kondo, Kenichiro Uemura, Naoya Nakagawa, Shingo Seo.

Quality control of data and algorithms: Yoshiaki Murakami, Naru Kondo, Kenichiro Uemura.

Data analysis and interpretation: Kenjiro Okada, Yoshiaki Murakami, Naru Kondo, Kenichiro Uemura, Naoya Nakagawa, Shingo Seo.

Statistical analysis: Kenjiro Okada, Yoshiaki Murakami, Naru Kondo, Kenichiro Uemura, Naoya Nakagawa.

Manuscript preparation: Kenjiro Okada, Yoshiaki Murakami, Naru Kondo, Kenichiro Uemura, Naoya Nakagawa.

Manuscript editing: Yoshiaki Murakami, Naru Kondo, Kenichiro Uemura.

Manuscript review: Kenjiro Okada, Yoshiaki Murakami, Naru Kondo.

Compliance with Ethical Standards

The study protocol and informed consent form were consistent with the recommendations of the Declaration of Helsinki and approved by the Institutional Review Board of Hiroshima University.

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Li D, Xie K, Wolff R, Abbruzzese JL. Pancreatic cancer. The Lancet. 2004;363:1049–1057.CrossRefGoogle Scholar
  2. 2.
    Hidalgo M. Pancreatic cancer. N Engl J Med. 2010;362:1605–1617.CrossRefGoogle Scholar
  3. 3.
    Kondo N, Murakami Y, Uemura K, et al. A phase 1 study of gemcitabine/nab-paclitaxel/S-1 (GAS) combination neoadjuvant chemotherapy for patients with locally advanced pancreatic adenocarcinoma. Cancer Chemother Pharmacol. 2017;79:775–781.CrossRefGoogle Scholar
  4. 4.
    Tol JA, Gouma DJ, Bassi C, et al. Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery. 2014;156:591–600.CrossRefGoogle Scholar
  5. 5.
    Brierley JD, Gospodarowicz MK, and Wittekind C. TNM classification of malignant tumours, eighth edition. Oxford, UK; Hoboken, NJ: John Wiley and Sons, Inc, 2017.Google Scholar
  6. 6.
    Amin MB, Edge SB, Greene FL, et al. AJCC Cancer Staging Manual (8th ed), New York, Springer, 2017.CrossRefGoogle Scholar
  7. 7.
    National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Pancreatic Adenocarcinoma. Version 2. 2018 ed 2018. Available from Accessed July 10, 2018.
  8. 8.
    Komo T, Murakami Y, Kondo N, et al. Prognostic Impact of Para-Aortic Lymph Node Micrometastasis in Pancreatic Ductal Adenocarcinoma. Ann Surg Oncol. 2016;23:2019–2027.CrossRefGoogle Scholar
  9. 9.
    Lee SE, Jang JY, Kim MA, Kim SW. Clinical implications of immunohistochemically demonstrated lymph node micrometastasis in resectable pancreatic cancer. J Korean Med Sci. 2011;26:881–885.CrossRefGoogle Scholar
  10. 10.
    Kurahara H, Takao S, Maemura K, et al. Impact of lymph node micrometastasis in patients with pancreatic head cancer. World J Surg. 2007;31:483–490; discussion 491-482.CrossRefGoogle Scholar
  11. 11.
    Kayahara M, Funaki K, Tajima H, et al. Surgical Implication of Micrometastasis for Pancreatic Cancer. Pancreas. 2010;39:884–888.CrossRefGoogle Scholar
  12. 12.
    Schwarz L, Lupinacci RM, Svrcek M, et al. Para-aortic lymph node sampling in pancreatic head adenocarcinoma. Br J Surg. 2014;101:530–538.CrossRefGoogle Scholar
  13. 13.
    Nimura Y, Nagino M, Takao S, et al. Standard versus extended lymphadenectomy in radical pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas: long-term results of a Japanese multicenter randomized controlled trial. J Hepatobiliary Pancreat Sci. 2012;19:230–241.CrossRefGoogle Scholar
  14. 14.
    Michalski CW, Kleeff J, Wente MN, et al. Systematic review and meta-analysis of standard and extended lymphadenectomy in pancreaticoduodenectomy for pancreatic cancer. Br J Surg. 2007;94:265–273.CrossRefGoogle Scholar
  15. 15.
    Golse N, Lebeau R, Lombard-Bohas C, et al. Lymph node involvement beyond peripancreatic region in pancreatic head cancers. Pancreas. 2013;42:239–248.CrossRefGoogle Scholar
  16. 16.
    Jamieson NB, Foulis AK, Oien KA, et al. Positive mobilization margins alone do not influence survival following pancreatico-duodenectomy for pancreatic ductal adenocarcinoma. Ann Surg. 2010;251:1003–1010.CrossRefGoogle Scholar
  17. 17.
    Kanda M, Fujii T, Nagai S, et al. Pattern of Lymph Node Metastasis Spread in Pancreatic Cancer. Pancreas. 2011;40:951–955.CrossRefGoogle Scholar
  18. 18.
    Malleo G, Maggino L, Capelli P, et al. Reappraisal of Nodal Staging and Study of Lymph Node Station Involvement in Pancreaticoduodenectomy with the Standard International Study Group of Pancreatic Surgery Definition of Lymphadenectomy for Cancer. J Am Coll Surg. 2015;221:367–379 e364.CrossRefGoogle Scholar
  19. 19.
    Shinchi H, Maemura K, Mataki Y, et al. A phase II study of oral S-1 with concurrent radiotherapy followed by chemotherapy with S-1 alone for locally advanced pancreatic cancer. J Hepatobiliary Pancreat Sci. 2012;19:152–158.CrossRefGoogle Scholar
  20. 20.
    Sudo K, Yamaguchi T, Ishihara T, et al. Phase II study of oral S-1 and concurrent radiotherapy in patients with unresectable locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys. 2011;80:119–125.CrossRefGoogle Scholar
  21. 21.
    Ishii H, Furuse J, Boku N, et al. Phase II study of gemcitabine chemotherapy alone for locally advanced pancreatic carcinoma: JCOG0506. Jpn J Clin Oncol. 2010;40:573–579.CrossRefGoogle Scholar
  22. 22.
    Ueno H, Ioka T, Ikeda M, et al. Randomized phase III study of gemcitabine plus S-1, S-1 alone, or gemcitabine alone in patients with locally advanced and metastatic pancreatic cancer in Japan and Taiwan: GEST study. J Clin Oncol. 2013;31:1640–1648.CrossRefGoogle Scholar
  23. 23.
    Okusaka T, Miyakawa H, Fujii H, et al. Updated results from GEST study: a randomized, three-arm phase III study for advanced pancreatic cancer. J Cancer Res Clin Oncol. 2017.Google Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Department of Surgery, Institute of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan

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