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Laparoscopic Dissection of Lymph Node Station 16—Why and How?

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Dissection of para-aortic lymph nodes (Station 16) provides an important prognosticator for patients with gastrointestinal, colorectal, and hepatobiliary cancers.1,2,3,4 For example, a positive Station 16 lymph node has been shown to lead to 2-year survival of 3% in patients with pancreas adenocarcinoma, akin to stage IV disease.5,6 Thereby, Station 16 involvement can help with the risk/benefit stratification of the decision to move forward with radical surgery.7,8,9 Furthermore, it has been shown for gallbladder cancer that involvement of Station 16 cannot necessarily be predicted from the dissection of the hepatoduodenal ligament lymph nodes only.10,11

Technique

With the patient in the French position, a complete Kocherization and a Cattel-Braasch maneuver is performed, allowing for visualization of LN station 16b. Station 16b is the inferior border of the station 16 compartment. The left renal vein (LRV) serves as an important landmark to identify the superior border of the dissection comprised by Stations 16a2 and 16b1. Station 16a2 dissection may be associated with a traction injury of the left renal vein or damage of right renal or suprarenal arteries and is dissected if there are specific concerns regarding involvement.

Conclusions

While station 16 provides important prognostic information for risk stratification, a strategic and stepwise approach is needed for a safe sampling. This is accomplished by wide mobilization of the duodenum, implementation of thermal fusion to minimize chyle leak, and careful dissection below the left renal vein.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Tufts University School of Medicine, Boston, MA, USA

    William Kawahara MS & Sebastian Mellado MS

  2. Department of Surgery, St. Elizabeth’s Medical Center, Boston University School of Medicine, Boston, MA, USA

    Eduardo A. Vega MD, Omid Salehi MD, Oscar Salirrosas MD, Richard Freeman MD, Elena Panettieri MD & Claudius Conrad MD, PhD, FACS, FSSO

  3. Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

    Elena Panettieri MD

Authors
  1. William Kawahara MS
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  2. Eduardo A. Vega MD
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  3. Omid Salehi MD
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  4. Sebastian Mellado MS
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  5. Oscar Salirrosas MD
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  6. Richard Freeman MD
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  7. Elena Panettieri MD
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  8. Claudius Conrad MD, PhD, FACS, FSSO
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Corresponding author

Correspondence to Claudius Conrad MD, PhD, FACS, FSSO.

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Kawahara, W., Vega, E.A., Salehi, O. et al. Laparoscopic Dissection of Lymph Node Station 16—Why and How?. Ann Surg Oncol 31, 3003–3004 (2024). https://doi.org/10.1245/s10434-024-15040-2

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  • DOI: https://doi.org/10.1245/s10434-024-15040-2

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