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Annals of Surgical Oncology

Published in:

01-09-2006

Extent of Lymph Node Retrieval and Pancreatic Cancer Survival: Information from a Large US Population Database

Authors: Roderich E. Schwarz, MD, David D. Smith, PhD

Published in: Annals of Surgical Oncology | Issue 9/2006

Abstract

Background

Operative therapy of pancreatic cancer is associated with poor survival because of high recurrence rates after pancreatectomy. The effect of lymph node (LN) dissection on survival continues to be debated.

Methods

A pancreatic cancer data set was created through structured queries to the Surveillance, Epidemiology, and End Results 1973 to 2000 database. Stage information was created according to 6th edition American Joint Committee on Cancer tumor-node-metastasis criteria, and the effect of LN number on survival was analyzed.

Results

Out of a cohort of 20,631 patients with carcinomas of the exocrine pancreas, surgical details were available for 2,787 patients. Procedures included pancreatoduodenectomies (n = 1848; 66%), radical regional pancreatectomies (n = 516; 19%), other partial resections (n = 316; 11%), and total pancreatectomies (n = 107; 4%). For 1666 of these patients with complete clinicopathologic information, the median age was 66 years (range, 22–96 years), with an equal sex ratio. The median number of total LNs examined was 7 (range, 1–52), of positive LNs was 1 (range, 0–34), and of negative LNs was 6 (range, 0–30). Multivariate survival analysis yielded these prognostic variables: number of LNs examined, number of positive LNs, tumor size, extrapancreatic extension, radiotherapy (all P < .0001), and age (P = .0009). The greatest survival differences were observed for negative LN counts of 10 to 15.

Conclusions

Stage-based survival prediction of pancreatic cancer is strongly influenced by total LN counts and numbers of negative LNs obtained. Although the mechanism remains unclear and could reflect confounding factors (margin status and institutional volume), an attempt to resect and examine at least 15 LNs to yield preferably between 10 and 15 negative LNs seems sensible for curative-intent pancreatectomy.

Sperti C, Pasquali C, Piccoli A, Pedrazzoli S. Recurrence after resection for ductal adenocarcinoma of the pancreas. World J Surg 1997;21:195–200PubMedCrossRef

Pisters PW, Wolff RA, Crane CH, Evans DB. Combined-modality treatment for operable pancreatic adenocarcinoma. Oncology (Williston Park) 2005;19:393–404, 409; discussion 409–10, 412–6

Stocken DD, Buchler MW, Dervenis C, et al. Meta-analysis of randomised adjuvant therapy trials for pancreatic cancer. Br J Cancer 2005;92:1372–81PubMedCrossRef

Harrison LE, Klimstra DS, Brennan MF. Isolated portal vein involvement in pancreatic adenocarcinoma. A contraindication for resection? Ann Surg 1996;224:342–7; discussion 347–9PubMedCrossRef

Tseng JF, Raut CP, Lee JE, et al. Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg 2004;8:935–49; discussion 949–50PubMedCrossRef

Fortner JG, Klimstra DS, Senie RT, Maclean BJ. Tumor size is the primary prognosticator for pancreatic cancer after regional pancreatectomy. Ann Surg 1996;223:147–53PubMedCrossRef

Kodera Y, Schwarz RE, Nakao A. Extended lymph node dissection in gastric carcinoma: where do we stand after the Dutch and British randomized trials? J Am Coll Surg 2002;195:855–64PubMedCrossRef

Havenga K, Enker WE, Norstein J, et al. Improved survival and local control after total mesorectal excision or D3 lymphadenectomy in the treatment of primary rectal cancer: an international analysis of 1411 patients. Eur J Surg Oncol 1999;25:368–74PubMedCrossRef

Pedrazzoli S, DiCarlo V, Dionigi R, et al. Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group. Ann Surg 1998;228:508–17PubMedCrossRef

10.

Yeo CJ, Cameron JL, Lillemoe KD, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg 2002;236:355–66; discussion 366–8PubMedCrossRef

11.

Nguyen TC, Sohn TA, Cameron JL, et al. Standard vs. radical pancreaticoduodenectomy for periampullary adenocarcinoma: a prospective, randomized trial evaluating quality of life in pancreaticoduodenectomy survivors. J Gastrointest Surg 2003;7:1–9; discussion 11PubMedCrossRef

12.

Pawlik TM, Abdalla EK, Barnett CC, et al. Feasibility of a randomized trial of extended lymphadenectomy for pancreatic cancer. Arch Surg 2005;140:584–9; discussion 589–91PubMedCrossRef

13.

Surveillance, Epidemiology, and End Results (SEER) Program: public use data (1973–2002). 2005. Available at: http://www.seer.cancer.gov/public data/access.html. Accessed April 8, 2005

14.

Greene FL, Page DL, Fleming ID, et al. American Joint Committee on Cancer Staging Manual. 6th ed. New York: Springer Verlag, 2002

15.

Smith DD, Schwarz RR, Schwarz RE. Impact of total lymph node counts on staging and survival after gastrectomy for gastric cancer: data from a large U.S. population database. J Clin Oncol 2005;23:7114–24PubMedCrossRef

16.

Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. Am Stat Assoc J 1958;53:457–81CrossRef

17.

Peto R, Pike MC. Conservatism in the approximation E(0−E)²/E in the log rank test for survival data or tumor incidence data. Biometrics 1973;29:579–84PubMedCrossRef

18.

Cox DR. Regression models and life tables. J R Stat Assoc B 1972;29:187–220

19.

Jemal A, Murray T, Ward E, et al. Cancer statistics, 2005. CA Cancer J Clin 2005;55:10–30PubMedCrossRef

20.

Henne-Bruns D, Vogel I, Luttges J, Kloppel G, Kremer B. Surgery for ductal adenocarcinoma of the pancreatic head: staging, complications, and survival after regional versus extended lymphadenectomy. World J Surg 2000;24:595–601; discussion 602PubMedCrossRef

21.

Gazzaniga GM, Cappato S, Papadia F, Mori L, Filauro M. D1 versus D2 pancreatoduodenectomy in surgical therapy of pancreatic head cancer. Hepatogastroenterology 2001;48:1471–8PubMed

22.

Popiela T, Kedra B, Sierzega M. Does extended lymphadenectomy improve survival of pancreatic cancer patients? Acta Chir Belg 2002;102:78–82PubMed

23.

Capussotti L, Massucco P, Ribero D, Vigano L, Muratore A, Calgaro M. Extended lymphadenectomy and vein resection for pancreatic head cancer: outcomes and implications for therapy. Arch Surg 2003;138:1316–22PubMedCrossRef

24.

Hirata K, Sato T, Mukaiya M, et al. Results of 1001 pancreatic resections for invasive ductal adenocarcinoma of the pancreas. Arch Surg 1997;132:771–6; discussion 777PubMed

25.

Lim JE, Chien MW, Earle CC. Prognostic factors following curative resection for pancreatic adenocarcinoma: a population-based, linked database analysis of 396 patients. Ann Surg 2003;237:74–85PubMedCrossRef

26.

Berger AC, Watson JC, Ross EA, Hoffman JP. The metastatic/examined lymph node ratio is an important prognostic factor after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am Surg 2004;70:235–40; discussion 240PubMed

27.

Gervasoni JE Jr, Taneja C, Chung MA, Cady B. Biologic and clinical significance of lymphadenectomy. Surg Clin North Am 2000;80:1631–73PubMedCrossRef

28.

Benassai G, Mastrorilli M, Mosella F, Mosella G. Significance of lymph node metastases in the surgical management of pancreatic head carcinoma. J Exp Clin Cancer Res 1999;18:23–8PubMed

29.

Kayahara M, Nagakawa T, Ueno K, Ohta T, Tsukioka Y, Miyazaki I. Surgical strategy for carcinoma of the pancreas head area based on clinicopathologic analysis of nodal involvement and plexus invasion. Surgery 1995;117:616–23PubMedCrossRef

30.

Nakao A, Harada A, Nonami T, et al. Lymph node metastases in carcinoma of the head of the pancreas region. Br J Surg 1995;82:399–402PubMedCrossRef

31.

Sakai M, Nakao A, Kaneko T, et al. Para-aortic lymph node metastasis in carcinoma of the head of the pancreas. Surgery 2005;137:606–11PubMedCrossRef

32.

Nagakawa T, Kobayashi H, Ueno K, Ohta T, Kayahara M, Miyazaki I. Clinical study of lymphatic flow to the paraaortic lymph nodes in carcinoma of the head of the pancreas. Cancer 1994;73:1155–62PubMedCrossRef

33.

Kayahara M, Nagakawa T, Futagami F, Kitagawa H, Ohta T, Miyazaki I. Lymphatic flow and neural plexus invasion associated with carcinoma of the body and tail of the pancreas. Cancer 1996;78:2485–91PubMedCrossRef

34.

Yoshida T, Matsumoto T, Sasaki A, Shibata K, Aramaki M, Kitano S. Outcome of paraaortic node-positive pancreatic head and bile duct adenocarcinoma. Am J Surg 2004;187:736–40PubMedCrossRef

35.

Schwarz RE, Smith DD, Keny H, et al. Impact of intraoperative radiation on postoperative and disease-specific outcome after pancreatoduodenectomy for adenocarcinoma: a propensity score analysis. Am J Clin Oncol 2003;26:16–21PubMedCrossRef

36.

Brennan MF, Kattan MW, Klimstra D, Conlon K. Prognostic nomogram for patients undergoing resection for adenocarcinoma of the pancreas. Ann Surg 2004;240:293–8PubMedCrossRef

Title: Extent of Lymph Node Retrieval and Pancreatic Cancer Survival: Information from a Large US Population Database
Authors: Roderich E. Schwarz, MD
David D. Smith, PhD
Publication date: 01-09-2006
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 9/2006
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-006-9016-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Extent of Lymph Node Retrieval and Pancreatic Cancer Survival: Information from a Large US Population Database

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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