Abstract
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.
Methods
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.
Results
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.
Conclusions
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.
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References
Li D, Xie K, Wolff R, Abbruzzese JL. Pancreatic cancer. The Lancet. 2004;363:1049–1057.
Hidalgo M. Pancreatic cancer. N Engl J Med. 2010;362:1605–1617.
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.
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.
Brierley JD, Gospodarowicz MK, and Wittekind C. TNM classification of malignant tumours, eighth edition. Oxford, UK; Hoboken, NJ: John Wiley and Sons, Inc, 2017.
Amin MB, Edge SB, Greene FL, et al. AJCC Cancer Staging Manual (8th ed), New York, Springer, 2017.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Pancreatic Adenocarcinoma. Version 2. 2018 ed 2018. Available from http://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf. Accessed July 10, 2018.
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.
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.
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.
Kayahara M, Funaki K, Tajima H, et al. Surgical Implication of Micrometastasis for Pancreatic Cancer. Pancreas. 2010;39:884–888.
Schwarz L, Lupinacci RM, Svrcek M, et al. Para-aortic lymph node sampling in pancreatic head adenocarcinoma. Br J Surg. 2014;101:530–538.
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.
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.
Golse N, Lebeau R, Lombard-Bohas C, et al. Lymph node involvement beyond peripancreatic region in pancreatic head cancers. Pancreas. 2013;42:239–248.
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.
Kanda M, Fujii T, Nagai S, et al. Pattern of Lymph Node Metastasis Spread in Pancreatic Cancer. Pancreas. 2011;40:951–955.
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.
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.
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.
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.
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.
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.
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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.
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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.
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The authors declare that they have no conflict of interest.
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Synopsis
In pancreatic head cancer, pancreatoduodenectomy with SMA-LN-lt dissection and adjuvant chemotherapy may contribute to the improvement of prognosis in patients with lymph node metastasis including SMA-LN-lt metastasis and micrometastasis.
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Okada, K., Murakami, Y., Kondo, N. et al. Prognostic Significance of Lymph Node Metastasis and Micrometastasis Along the Left Side of Superior Mesenteric Artery in Pancreatic Head Cancer. J Gastrointest Surg 23, 2100–2109 (2019). https://doi.org/10.1007/s11605-019-04359-x
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DOI: https://doi.org/10.1007/s11605-019-04359-x