Appropriate Lymph Node Dissection Sites for Cancer in the Body and Tail of the Pancreas: A Multicenter Retrospective Study.
Appropriate Lymph Node Dissection Sites for Cancer in the Body and Tail of the Pancreas: A Multicenter Retrospective Study.
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DOI：
10.3390/cancers14184409
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发表时间：
2022-09-11
期刊：
影响因子：
5.2
通讯作者：
Hirano, Satoshi
中科院分区：
文献类型：
--
作者：
Tanaka, Kimitaka;Kimura, Yasutoshi;Hayashi, Tsuyoshi;Ambo, Yoshiyasu;Yoshida, Makoto;Umemoto, Kazufumi;Murakami, Takeshi;Asano, Toshimichi;Nakamura, Toru;Hirano, Satoshi
胰腺远端切除术已成为胰腺体尾癌患者的标准手术方式。解剖的最佳区域仍然存在争议，强调在根除癌症的同时尽可能多地保留组织。这项多中心的回顾性研究评估了235例胰腺体尾癌患者基于肿瘤部位的淋巴结转移的频率和模式，以确定胰腺远端切除的最佳淋巴清扫区域。2例胰腺体癌患者均未见脾门部淋巴转移。保脾胰腺切除术治疗铅癌可能是可行的。胰腺远端切除加淋巴清扫是治疗胰腺体尾癌的标准手术方式。然而，DP的最佳淋巴清扫区域仍然存在争议。因此，我们根据肿瘤部位评估了LN转移的频率和模式。在这项多中心的回顾性研究中，我们检查了235名因胰腺癌接受DP治疗的患者。肿瘤部位分为胰体(Pb)和胰尾(Pt)。疗效指数(EI)是通过将转移到每个LN站的频率乘以转移到该站的患者的5年生存率来计算的。有132/235(56.2%)的患者发生淋巴结转移。2例铅瘤均未见脾门层淋巴结转移。对于Pb型和Pt型肿瘤，脾远端动脉LNS和肝前上/后总动脉LNS分别不能从解剖中受益。在多因素分析中，脾动脉LN转移被确定为胰腺体尾癌患者总体生存不良的独立预测因素。总之，仅限于铅或铂的胰腺体尾癌转移的LN部位有明显的差异。保脾胰腺切除术治疗铅癌可能是可行的。
Distal pancreatectomy has become the standard surgery for patients with pancreatic body–tail cancers. The optimal area for dissection remains controversial, and there is an emphasis on preserving as much tissue as possible while eradicating the cancer. This multicenter, retrospective study evaluated the frequency and patterns of lymph node metastasis based on tumor site among 235 patients with pancreatic body–tail cancers to determine the optimal lymph node dissection area for distal pancreatectomy. Patients with pancreatic body cancer tumors showed no metastasis to the splenic hilum lymph node. Spleen-preserving pancreatectomy might be feasible for Pb cancer. Distal pancreatectomy (DP) with lymphadenectomy is the standard surgery for pancreatic body–tail cancer. However, the optimal lymph node (LN) dissection area for DP remains controversial. Thus, we evaluated the frequency and patterns of LN metastasis based on the tumor site. In this multicenter retrospective study, we examined 235 patients who underwent DP for pancreatic cancer. Tumor sites were classified as confined to the pancreatic body (Pb) or pancreatic tail (Pt). The efficacy index (EI) was calculated by multiplying the frequency of metastasis to each LN station by the five-year survival rate of patients with metastasis to that station. LN metastasis occurred in 132/235 (56.2%) of the patients. Patients with Pb tumors showed no metastasis to the splenic hilum LN. Distal splenic artery LNs and anterosuperior/posterior common hepatic artery LNs did not benefit from dissection for Pb and Pt tumors, respectively. In multivariate analysis, splenic artery LN metastasis was identified as an independent predictor of poor overall survival in patients with pancreatic body–tail cancer. In conclusion, differences in metastatic LN sites were evident in pancreatic body–tail cancers confined to the Pb or Pt. Spleen-preserving pancreatectomy might be feasible for Pb cancer.
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