Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS).
Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS).
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DOI：
10.1016/j.surg.2014.06.016
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发表时间：
2014-09
期刊：
影响因子：
3.8
通讯作者：
International Study Group on Pancreatic Surgery
中科院分区：
文献类型：
--
作者：
Tol JA;Gouma DJ;Bassi C;Dervenis C;Montorsi M;Adham M;Andrén-Sandberg A;Asbun HJ;Bockhorn M;Büchler MW;Conlon KC;Fernández-Cruz L;Fingerhut A;Friess H;Hartwig W;Izbicki JR;Lillemoe KD;Milicevic MN;Neoptolemos JP;Shrikhande SV;Vollmer CM;Yeo CJ;Charnley RM;International Study Group on Pancreatic Surgery
背景胰腺导管腺癌患者淋巴结状况是预后的重要指标。然而，在胰腺切除术中扩大淋巴结切除术的生存益处是有争议的，并且没有真正定义淋巴结切除术的最佳范围。本研究的目的是制定一个标准的淋巴结切除术的定义在pancrectomy.MethodsDuring胰腺手术的国际研究小组的共识会议，胰腺外科医生制定了一个共识声明，根据现有的文献和他们的experience.ResultsThe命名的日本胰腺学会被所有参与者接受。与标准淋巴结切除术相比，胰十二指肠切除术中沿上级肠系膜动脉（SMA）左侧和腹腔干、脾动脉或胃左动脉切除Ln的沿着淋巴结切除术没有显示出生存益处。无I级证据可用于评估主动脉旁Ln阳性的预后影响。就选择性地去除切除区域外的可疑Ln进行冷冻切片达成了共识。没有达成共识，继续或终止切除的情况下，这些节点是positive.ConclusionExtended淋巴结切除术不能推荐。胰腺癌切除术的标准淋巴结切除术应尽量切除Ln 5、6、8a、12b1、12b2、12c、13a、13b、14a、14b、17a和17b号站点。对于胰腺体部和尾部的癌症，移除站10、11和18是标准的。此外，淋巴结切除术对于充分的淋巴结分期是重要的。在切除平面外LN阳性的病例中，对相对健康的患者进行胰腺切除或非切除姑息治疗都是可接受的治疗。这一共识声明可以作为外科医生和研究人员在未来的指令和新的临床研究的指导。
BackgroundThe lymph node (Ln) status of patients with resectable pancreatic ductal adenocarcinoma is an important predictor of survival. The survival benefit of extended lymphadenectomy during pancreatectomy is, however, disputed, and there is no true definition of the optimal extent of the lymphadenectomy. The aim of this study was to formulate a definition for standard lymphadenectomy during pancreatectomy.MethodsDuring a consensus meeting of the International Study Group on Pancreatic Surgery, pancreatic surgeons formulated a consensus statement based on available literature and their experience.ResultsThe nomenclature of the Japanese Pancreas Society was accepted by all participants. Extended lymphadenectomy during pancreatoduodenectomy with resection of Ln's along the left side of the superior mesenteric artery (SMA) and around the celiac trunk, splenic artery, or left gastric artery showed no survival benefit compared with a standard lymphadenectomy. No level I evidence was available on prognostic impact of positive para-aortic Ln's. Consensus was reached on selectively removing suspected Ln's outside the resection area for frozen section. No consensus was reached on continuing or terminating resection in cases where these nodes were positive.ConclusionExtended lymphadenectomy cannot be recommended. Standard lymphadenectomy for pancreatoduodenectomy should strive to resect Ln stations no. 5, 6, 8a, 12b1, 12b2, 12c, 13a, 13b, 14a, 14b, 17a, and 17b. For cancers of the body and tail of the pancreas, removal of stations 10, 11, and 18 is standard. Furthermore, lymphadenectomy is important for adequate nodal staging. Both pancreatic resection in relatively fit patients or nonresectional palliative treatment were accepted as acceptable treatment in cases of positive Ln's outside the resection plane. This consensus statement could serve as a guide for surgeons and researchers in future directives and new clinical studies.
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影响因子：
9.6
作者：
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通讯作者：
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DOI：
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