Impact of Lymph Node Micrometastasis in Patients with Pancreatic Head Cancer

Excerpt

It is generally accepted that lymph node metastases are present in >50% of patients with pancreatic cancer at the time of diagnosis. Although not a contraindication to resection, positive lymph node status is one of the few well-described negative prognostic factors for pancreatic cancer. Preoperative assessment of lymph node status continues to be unreliable. Because regional recurrence is a common phenomenon, many investigators have postulated that extended lymph node dissections will improve local control of the disease and result in improved survival rates. Several retrospective studies, mainly from Japan, have suggested improved survival benefit with extended lymph node dissection. 1,2 Significant improvement in survival has not been demonstrated in at least two prospective, randomized studies performed in Europe and the United States.3‐5 These studies did indicate that increased numbers of lymph nodes could be harvested with extended dissection, while factors such as OR time, length of stay, and mortality were not affected. The studies from Johns Hopkins did identify an increased risk of pancreatic fistula and delayed gastric emptying with extended resection.4,5 Debilitating postoperative diarrhea is also a well-described complication of radical pancreatic head resection, but may be prevented by excluding dissection of the nerve plexus along the left side of the superior mesenteric artery.6 …