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para-aortic lymph node involvement should not be a contraindication to resection of pancreatic ductal adenocarcinoma

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World Journal of Gastrointestinal Surgery 2022年第5期14卷 429-441页

作者： Rupaly Pande Shafiq Chughtai Manish Ahuja Rachel Brown David C Bartlett Bobby V Dasari Ravi Marudanayagam Darius Mirza Keith Roberts John Isaac Robert P Sutcliffe Nikolaos A Chatzizacharias Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery University Hospitals Birmingham NHS Foundation TrustBirmingham B152GWUnited Kingdom Department of Pathology University Hospitals Birmingham NHS Foundation TrustBirmingham B152GWUnited Kingdom

BACKGROUND para-aortic lymph nodes(PALN)are found in the aortocaval groove and they are staged as metastatic disease if involved by pancreatic ductal adenocarcinoma(PDAC).The data in the literature is conflicting with some studies having associated PALN involvement with poor prognosis,while others not sharing the same *** resection is not included in the standard lymphadenectomy during pancreatic resections as per the International Study Group for Pancreatic Surgery and there is no consensus on the management of these *** To investigate the prognostic significance of PALN metastases on the oncological outcomes after resection for *** This is a retrospective cohort study of data retrieved from a prospectively maintained database on consecutive patients undergoing pancreatectomies for PDAC where PALN was sampled between 2011 and *** comparison of the data between PALN+and PALN-subgroups,survival analysis with the Kaplan-Meier method and risk analysis with univariable and multivariable time to event Cox regression analysis were performed,specifically assessing oncological outcomes such as median overall survival(OS)and disease-free survival(DFS).RESULTS 81 cases had PALN sampling and 17(21%)were *** N stage was significantly different between PALN+and PALN-patients(P=0.005),while no difference was observed in any of the other *** imaging diagnosed PALN positivity in one *** and DFS were comparable between PALN+and PALN-patients with lymph node positive disease(OS:13.2 mo vs 18.8 mo,P=0.161;DFS:13 mo vs 16.4 mo,P=0.179).No difference in OS or DFS was identified between PALN positive and negative patients when they received chemotherapy either in the neoadjuvant or in the adjuvant setting(OS:23.4 mo vs 20.6 mo,P=0.192;DFS:23.9 mo vs 20.5 mo,P=0.718).On the contrary,when patients did not receive chemotherapy,PALN disease had substantially shorter OS(5.5 mo vs 14.2 mo;P=0.015)and DFS(4.4 mo

关键词： para-aortic lymph node Pancreatectomy Survival Pancreatic adenocarcinoma Chemotherapy lymph node sampling

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Prognostic value of para-aortic lymph node metastasis and dissection for pancreatic head ductal adenocarcinoma: a retrospective cohort study

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胰腺病学杂志(英文) 2024年第03期

作者： Xu Yecheng Yang Feng Fu Deliang Department of Pancreatic Surgery Huashan Hospital Fudan University Shanghai China

Background: para-aortic lymph node (PALN) metastasis affects approximately 20% of patients with pancreatic ductal adenocarcinoma (PDAC). However, the prognostic significance of PALN metastases and dissection remains ***: This retrospective cohort study included patients with PDAC of the pancreatic head who had undergone pancreati-coduodenectomy (PD) at our center between January 2017 and December ***: A total of 234 patients were included in the study. PALN dissection improved the median overall survival (OS) without statistical significance (24.1 vs 18.1 months,P = .156). The median recurrence-free survival was significantly longer in the PALN-dissection group than the group without PALN dissection (18.2 vs 11.6 months,P = .040). Conversely, there were no significant differences in the long-term prognosis between the PALN-positive and PALN-negative subgroups in the PALN-dissection group. Multivariate analysis showed that PALN metastasis was not an independent risk factor for OS (hazard ratio: 0.831, 95% confidence interval: 0.538–1.285,P = .406).Conclusions: For patients with pancreatic head ductal adenocarcinoma, PD with PALN dissection may achieve survival prolongation and bridge the survival gap between patients with and without PALN metastasis without significantly increasing the perioperative risks.

关键词： Pancreatic ductal adenocarcinoma Pancreaticoduodenectomy para-aortic lymph node Survival Textbook outcome

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CA19-9 level determines therapeutic modality in pancreatic cancer patients with para-aortic lymph node metastasis

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Hepatobiliary & Pancreatic Diseases International 2018年第1期17卷 75-80页

作者： Tadafumi Asaoka Atsushi Miyamoto Sakae Maeda Naoki Hama Masanori Tsujie Masataka Ikeda Mitsugu Sekimoto Shoji Nakamori Department of Surgery National Hospital Organization Osaka National Hospital

Background: In general, para-aortic lymph node(LN16) metastasis has been considered as a contraindication for pancreatic resection. However, some pancreatic cancer patients with LN16 metastasis have been reported to survive for longer than expected after pancreatectomy. The purpose of this study was to determine whether pancreatic cancer patients with LN16 metastasis might benefit from ***: We retrospectively reviewed 201 consecutive patients with invasive pancreatic ductal adenocarcinoma who underwent surgery at Osaka National Hospital between April 2003 and December *** patients included 22 patients with LN16 metastasis who underwent an extended lymphadenectomy and 25 patients who underwent a palliative surgical biliary and gastric bypass. The clinicopathological data and outcomes were evaluated using univariate and multivariate ***: The overall survival of the patients with LN16 metastasis was poorer than that of the LN16-negative patients(P = 0.0014). An overall survival analysis of the LN16-positive patients stratified according to the preoperative CA19-9 level showed a significant difference between patients with a low preoperative CA19-9 level(≤360 U/mL) and those with a high preoperative CA19-9 level(>360 U/mL)(P = 0.0301). No significant difference in overall survival of patients was observed between those with LN16 positivity and those who underwent bypass surgery. However, the overall survival of the LN16-positive patients with a CA19-9 level ≤360 U/mL(n = 11) was significantly higher than that of those who underwent bypass surgery(P = 0.0452).Conclusion: Surgical resection and extended lymphadenectomy remains an option for pancreatic cancer patients with LN16-positivity whose CA19-9 level is ≤360 U/mL.

关键词： Pancreatic cancer CA19-9 para-aortic lymph node

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Clinical significance of para-aortic lymph node dissection and prognosis in ovarian cancer

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Frontiers of Medicine 2014年第1期8卷 96-100页

作者： Xianxian Li Hui Xing Lin Li Yanli Huang Min Zhou Qiong Liu Xiaomin Qin Min He Department of Obstetrics and Gynecology Xiangyang Central Hospital Hospital Affiliated to Hubei University of Arts and ScienceXiangyang 441021 China

lymph node metastasis has an important effect on prognosis of patients with ovarian cancer. Moreover, the impact of para-aortic lymph node （PAN） removal on patient prognosis is still unclear. In this study, 80 patients were divided into groups A and B. Group A consisted of 30 patients who underwent PAN ＋ pelvic lymph node （PLN） dissection, whereas group B consisted of 50 patients who only underwent PLN dissection. Analysis of the correlation between PAN clearance and prognosis in epithelial ovarian cancer was conducted. Nineteen cases of lymph node metastasis were found in group A, among whom seven cases were positive for PAN, three cases for PLN, and nine cases for both PAN and PLN. In group B, 13 cases were positive for lymph node metastasis. Our study suggested that the metastatic rate of lymph node is 40.0%. lymph node metastasis was significantly correlated with FIGO stage, tumor differentiation, and histological type both in groups A and B （P 〈 0.05）. In groups A and B, the three-year survival rates were 77.9% and 69.0%, and the five-year survival rates were 46.7% and 39.2%, respectively. However, the difference was not statistically significant （P 〉 0.05）. The three-year survival rates of PLN metastasis in groups A and B were 68.5% and 41.4%, and the five-year survival rates were 49.7% and 26.4%, respectively. Furthermore, PLN-positive patients who cleared PAN had significantly higher survival rate （P = 0.044）. In group A, the three-year survival rates of positive and negative lymph nodes were 43.5% and 72.7%, and the five-year survival rates were 27.2% and 58.5%, respectively. The difference was statistically significant （P= 0.048）. Cox model analysis of single factor suggested that lymph node status affected the survival rate （P 〈 0.01）, which was the death risk factor. Consequently, in ovarian carcinoma cytoreductive surgery, resection of the para-aortic lymph node, which has an important function in clinical treatment and prognosis of patients with ovaria

关键词： ovarian cancer para-aortic lymph node pelvic lymph node

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para-aortic lymph node(PAN) assessment and its surgical indication in patients with stage IB-IIA cervical cancer

Para-aortic lymph node(PAN) assessment and its surgical indi...

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中华医学会第十次全国妇产科学术会议妇科肿瘤会场（妇科肿瘤学组、妇科病理学组）

作者： Jin Li Yuqi Zhou Xiaohua Wu Department of Gynecologic Oncology Fudan University Cancer Center

Objective To investigate the frequency of PAN involvement in stageⅠB-ⅡA cervical carcinoma and to determine the indication of para-aortic lymphadenectomy Methods Medical records of 517 patients with StagesⅠB-ⅡA cervical carcinoma who underwent radical hysterectomy and systematic pelvic and PAN dissection from 2005 to 2010 were investigated retrospectively.522

关键词： DFS PAN para-aortic lymph node assessment and its surgical indication in patients with stage IB-IIA cervical cancer

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Advances in para-aortic nodal dissection in gastric cancer surgery: A review of research progress over the last decade

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World Journal of Clinical Cases 2020年第13期8卷 2703-2716页

作者： Yin-Ping Dong Jing-Yu Deng Department of Gastroenterology Tianjin Medical University Cancer HospitalCity Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for CancerTianjin 300060China

Approximately 17%-40%of para-aortic lymph node(PAN)metastasis occurs in patients with advanced gastric *** the third tier of lymphatic drainage of the stomach and the final station in front of the systemic circulation,PAN infiltration is defined as distant metastasis and plays a key role in the evaluation of the prognosis of advanced gastric *** clinical factors including tumor size≥5 cm,pT3 or pT4 depth of tumor invasion,pN2 and pN3 stages,the macroscopic type of Borrmann Ⅲ/Ⅳ,and the diffuse/mixed Lauren classification are indicators of PAN *** PAN dissection(PAND)should be performed on patients with or without the macroscopic PAN invasion remains unascertained,regardless of the numerous retrospective comparative studies reported on the improved prognosis over D2 *** paradoxical result from many other studies showed no significant difference in the overall survival between these two lymphadenectomies.A phase Ⅱ trial launched by the Japan Clinical Oncology Group indicated that two or three courses of S-1 and cisplatin preoperatively followed by radical surgery with D2+PAND and postoperative S-1 is the current standard strategy for the treatment of patients with extensive lymph node metastasis,and this regimen could be substituted by a promising strategy with effective combination chemotherapy or suitable chemotherapy *** review focuses on the advances in radical gastrectomy plus PAND with or without chemotherapy for patients with advanced gastric cancer.

关键词： para-aortic lymph node lymphadenectomy Stomach Neoplasm

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