Clinical Impact of Unexpected Para-Aortic Lymph Node Metastasis in Surgery for Resectable Pancreatic Cancer

Radiologically identified para-aortic lymph node (PALN) metastasis is contraindicated for pancreatic cancer (PC) surgery. There is no clinical consensus for unexpected intraoperative PALN enlargement. To analyze the prognostic role of unexpected PALN enlargement in resectable PC, we retrospectively reviewed data of 1953 PC patients in a single tertiary center. Patients with unexpected intraoperative PALN enlargement (group A1, negative pathology, n = 59; group A2, positive pathology, n = 13) showed median overall survival (OS) of 24.6 (95% CI: 15.2–33.2) and 13.0 (95% CI: 4.9–19.7) months, respectively. Patients with radiological PALN metastasis without other metastases (group B, n = 91) showed median OS of 8.6 months (95% CI: 7.4–11.6). Compared with group A1, groups A2 and B had hazard ratios (HRs) of 2.79 (95% CI, 1.4–5.7) and 2.67 (95% CI: 1.8–4.0), respectively. Compared with group A2, group B had HR of 0.96 (95% CI: 0.5–1.9). Multivariable analysis also showed positive PALN as a negative prognostic factor (HR 2.57, 95% CI: 1.2–5.3), whereas positive regional lymph node did not (HR 1.32 95% CI: 0.8–2.3). Thus, unexpected malignant PALN has a negative prognostic impact comparable to radiological PALN metastasis. This results suggests prompt pathologic evaluation for unexpected PALN enlargements is needed and on-site modification of surgical strategy would be considered.

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Clinical Impact of Unexpected Para-Aortic Lymph Node Metastasis in Surgery for Resectable Pancreatic Cancer

10.21203/rs.3.rs-386384/v1 ◽

2021 ◽

Author(s):

Ho-Kyoung Lee ◽

Yoo-Seok Yoon ◽

Ho-Seong Han ◽

Jun Suh Lee ◽

Hee Young Na ◽

...

Keyword(s):

Pancreatic Cancer ◽

Lymph Node ◽

Absolute Number ◽

Prognostic Impact ◽

Resectable Pancreatic Cancer ◽

Regional Lymph Nodes ◽

Tertiary Centre ◽

Pathologic Evaluation ◽

Aortic Lymph Node ◽

Group B

Abstract Radiologically identified para-aortic lymph node (PALN) metastasis is contraindicated for pancreatic cancer (PC) surgery. There is no clinical consensus for unexpected intraoperative PALN. To analyse the prognostic role of unexpected PALN in resectable PC, we retrospectively reviewed data of 1,953 PC patients in a single tertiary centre. Patients with intraoperative PALN without radiological PALN (group A1, negative pathology, n = 59; group A2, positive pathology, n = 13) showed median overall survival (OS) of 24.6 (95% confidence interval [CI]: 15.2–33.2) and 13.0 (95%CI: 4.9–19.7) months, respectively. Patients with radiological PALN metastasis without other metastases (group B, n = 91) showed median OS of 8.6 months (95%CI: 7.4–11.6). Compared with group B, groups A1 and A2 had hazard ratios (HRs) of 0.37 (95%CI, 0.2–0.6) and 1.04 (95%CI: 0.7–1.4), respectively. Compared with group A2, group A1 had HR of 0.33 (95%CI: 0.2–0.7). Analysing regional lymph nodes (LNs), the positive LN ratio affected survival (HR: 2.67, 95%CI: 1.6–4.5), while the absolute number of positive LNs (HR: 1.79, 95%CI: 0.7–4.6) did not. Thus, unexpected malignant PALN has a negative prognostic impact comparable to radiological PALN metastasis. Prompt pathologic evaluation for unexpected PALN and maximal harvest of regional LNs during PC surgery are suggested.

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The prognostic impact of para-aortic lymph node metastasis in pancreatic cancer: A systematic review and meta-analysis

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2016.02.003 ◽

2016 ◽

Vol 42 (5) ◽

pp. 616-624 ◽

Cited By ~ 28

Author(s):

S. Paiella ◽

M. Sandini ◽

L. Gianotti ◽

G. Butturini ◽

R. Salvia ◽

...

Keyword(s):

Systematic Review ◽

Pancreatic Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Meta Analysis ◽

Prognostic Impact ◽

Node Metastasis ◽

Aortic Lymph Node

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The prognostic impact of para-aortic lymph node metastasis in pancreatic cancer: A systematic review and meta-analysis

HPB ◽

10.1016/j.hpb.2016.01.253 ◽

2016 ◽

Vol 18 ◽

pp. e756

Author(s):

S. Paiella ◽

M. Sandini ◽

L. Gianotti ◽

R. Salvia ◽

C. Bassi ◽

...

Keyword(s):

Systematic Review ◽

Pancreatic Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Meta Analysis ◽

Prognostic Impact ◽

Node Metastasis ◽

Aortic Lymph Node

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Adjuvant chemoradiation to improve survival compared to adjuvant chemotherapy in selected patients with pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.330 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 330-330

Author(s):

Aryavarta M. S. Kumar ◽

Gavin Falk ◽

Kevin L. Stephans ◽

Matthew Walsh ◽

Robert James Pelley ◽

...

Keyword(s):

Pancreatic Cancer ◽

Adjuvant Chemotherapy ◽

Multivariable Analysis ◽

Surgical Margin ◽

Positive Surgical Margin ◽

Resectable Pancreatic Cancer ◽

Adjuvant Chemoradiation ◽

Distant Failure ◽

Node Ratio ◽

Group B

330 Background: While surgery remains the only potential curative option for resectable pancreatic cancer, adjuvant therapy improves outcomes over surgery alone; however, adjuvant recommendations of chemotherapy vs chemoradiation remain controversial. We present outcomes comparing the two adjuvant treatments. Methods: In our single institution review, 343 patients (2000-2012) had pancreatoduodenectomy for pancreatic cancer. Medical oncology made adjuvant recommendations. Chemotherapy was gemcitabine or 5-FU and radiotherapy prescription was 45-54 Gy. Locoregional recurrences (LRR) were operative bed or regional nodal failures. Results: Median follow up and median survival (MS) for all patients was 17.5 and 19.5 mo respectively. 130 patients had resection alone (A), 84 had adjuvant chemotherapy (B), and 129 had adjuvant chemoradiation (C). MS for groups A, B, and C were 13, 23 and 26 mo respectively. Locoregional recurrence (LRR) was 60%, 63%, and 38% and distant failure was 64%, 65%, and 66% for groups A, B, and C respectively. Group C had significantly lower LRR compared to group B (p=0.01) however, survival between groups B and C was not statistically significant (p=0.23). Angiolymphatic invasion (ALI) and perineural invasion were correlated with LRR (p<0.01). Multivariable analysis showed LRR, laparoscopy, ALI, and the interaction term of LRR with surgical margin were significant predictors of survival (p<0.05). MS of patients with lymph node ratio (LNR) > 0.2 and LNR ≤ 0.2 was 18 and 27 mo respectively. Subgroup analysis showed survival advantages to adjuvant chemoradiation compared with adjuvant chemotherapy. R1 resections in groups B and C were 37% and 39% (p=ns) with MS of 16 vs 27 mo respectively (p=0.01). For patients with ≥ 8 LN dissected and LNR ≤ 0.2, MS was 24 vs 32 mo for groups B and C respectively (p=0.04). Conclusions: Adjuvant chemoradiation significantly decreases LRR in resected pancreatic cancer patients. Compared to adjuvant chemotherapy alone, adjuvant chemoradiation improved survival for patients with a 1) positive surgical margin and/or 2) LNR ≤ 0.2 with ≥ 8 LNs dissected.

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Role of para-aortic lymph node sampling in pancreatic cancer surgery.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.715 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 715-715

Author(s):

Yusuke Kazami ◽

Hiromichi Ito ◽

Yoshihiro Ono ◽

Takafumi Sato ◽

Yosuke Inoue ◽

...

Keyword(s):

Pancreatic Cancer ◽

Lymph Node ◽

Pancreatic Resection ◽

Pancreatic Head ◽

Imaging Study ◽

Resectable Pancreatic Cancer ◽

Lymph Node Sampling ◽

Aortic Lymph Node

715 Background: In the management of pancreatic cancer, para-aortic lymph node (PALN) metastasis is regarded as distant metastasis, and systemic treatment is recommended. However, imaging study is not perfect to detect all PALN metastasis and the management of intraoperatively discovered PALN has been controversial. We hypothesized that sampling of PALNs on exploration could allow us to avoid pancreatic resection for patients who would not benefit. In this study, we evaluated the incidence and the effect on the long-term outcomes for patients with potentially resectable pancreatic cancer. Methods: Three hundred and ninety-two patients who had PALNs sampled upon potentially resectable pancreatic cancer from 2005 through 2014 were included in the study. All patients were appropriately staged preoperatively with CT/MRI and those with suspected PALN metastasis were not considered as candidates for resection. The patients whose resections were aborted because of liver metastasis or peritoneal dissemination discovered on exploration, or those who died within 30-days after the operation were not included. Evaluated outcomes were incidence of PALN metastasis and their recurrence-free and overall survivals (RFS, OS). Results: The patients’ median age was 74 years, and 58.6% was man. 67.8% had tumors at pancreatic head. Preoperative chemotherapy was given only on 16 patients (3.2%). Among 392 patients with PALNs sampled, 53 (13.5%) patients had metastasis; Resection was completed on 40 patients and resection was aborted on the rest. Among patients who underwent pancreatic resection, median RFS and OS were 10 and 12 months for patients with PALN metastasis, compared to 17 and 26 months for those without PALN metastasis (p < 0.001 for RFS and p < 0.001 for OS). The 5-year-OS rates for patients with/without PALN metastasis were 5.9% and 25% (p < 0.001). Among 53 patients with PALN metastasis, OS were not different between the patients who underwent resection and those who did not (median 13 months vs 17 months, p = 0.06), and there were no recurrence-free survivors. Conclusions: PALN sampling and evaluation before committing to resection is useful to identify the patients who can unlikely benefit and to avoid unnecessary morbid operation.

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Prognostic Implication of Para-aortic Lymph Node Metastasis in Resectable Pancreatic Cancer

World Journal of Surgery ◽

10.1007/s00268-005-0730-5 ◽

2006 ◽

Vol 31 (1) ◽

pp. 147-154 ◽

Cited By ~ 55

Author(s):

Ryuichiro Doi ◽

Kazuhiro Kami ◽

Daisuke Ito ◽

Koji Fujimoto ◽

Yoshiya Kawaguchi ◽

...

Keyword(s):

Pancreatic Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Resectable Pancreatic Cancer ◽

Prognostic Implication ◽

Node Metastasis ◽

Aortic Lymph Node

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Significance of Concurrent Chemoradiotherapy as Primary Treatment in Patients with Metastatic Cervical Cancer

Current Oncology ◽

10.3390/curroncol28030155 ◽

2021 ◽

Vol 28 (3) ◽

pp. 1663-1672

Author(s):

Satomi Hattori ◽

Nobuhisa Yoshikawa ◽

Kazumasa Mogi ◽

Kosuke Yoshida ◽

Masato Yoshihara ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Tumor Size ◽

Concurrent Chemoradiotherapy ◽

Primary Treatment ◽

Prognostic Impact ◽

Primary Tumor Size ◽

Node Metastasis ◽

Aortic Lymph Node

(1) This study investigated the prognostic impact of tumor size in patients with metastatic cervical cancer. (2) Methods: Seventy-three cervical cancer patients in our institute were stratified into two groups based on distant metastasis: para-aortic lymph node metastasis alone (IIIC2) or spread to distant visceral organs with or without para-aortic lymph node metastasis (IVB) to identify primary tumor size and concurrent chemoradiotherapy. (3) Results: The overall survival (OS) for patients with a tumor >6.9 cm in size was significantly poorer than that for patients with a tumor ≤6.9 cm in the IVB group (p = 0.0028); the corresponding five-year OS rates in patients with a tumor ≤6.9 and >6.9 cm were 53.3% and 13.4%, respectively. In the multivariate analysis, tumor size and primary treatment were significantly associated with survival in metastatic cervical cancer. (4) Conclusions: Tumor size ≤6.9 cm and concurrent chemoradiotherapy as the primary treatment were favorable prognostic factors for patients with metastatic cervical cancer.

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