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Published in:

01-01-2007

Impact of Regional Lymph Node Evaluation in Staging Patients With Periampullary Tumors

Authors: Shishir K. Maithel, MD, Korosh Khalili, MD, Elijah Dixon, MD, Maha Guindi, MD, Mark P. Callery, MD, Mark S. Cattral, MD, Bryce R. Taylor, MD, Steven Gallinger, MD, Paul D. Greig, MD, David R. Grant, MD, Charles M. Vollmer Jr., MD

Published in: Annals of Surgical Oncology | Issue 1/2007

Abstract

Background

Two distinct lymph nodes reproducibly assessed by computed tomography for the evaluation of periampullary tumors are the common bile duct (CBD) node and the gastroduodenal artery (GDA) node. We examined whether radiographical enlargement of either lymph node predicts tumor resectability, nodal metastasis, or patient survival.

Methods

Ninety-four consecutive patients underwent attempted curative resection of periampullary tumors between September 2001 and June 2003. A single radiologist recorded in a retrospective, blinded fashion the short- and long-axis measurements of the CBD and GDA nodes.

Results

Sixty-one percent (n = 57) of tumors were resectable by pancreaticoduodenectomy. Overall, actual 6-, 12-, and 18-month survival was 87%, 68%, and 63%, respectively. Enlarged radiographical nodal size by either axis was not associated with the presence of metastasis to these lymph nodes or with reduced overall patient survival. Only a CBD node short-axis size >10 mm predicted unresectability (odds ratio, 3.2; P = .036). Liver metastasis and/or carcinomatosis were present in 43% of unresectable patients, and this was associated with decreased survival at both 1 year (25% vs. 77%; P < .001) and 18 months (19% vs. 72%; P <.001). A pathologic diagnosis of metastasis to the GDA node, but not the CBD node, was associated with a similarly decreased survival (1 year: 33% vs. 78%, P = .028; 18 months: 22% vs. 70%, P = .023).

Conclusions

For presumed periampullary malignancy, a CBD node short-axis size >10 mm predicts tumor unresectability. Metastatic disease to the GDA node, particularly for pancreatic adenocarcinoma, portends a poor prognosis equivalent to that of hepatic or peritoneal spread. Given these findings, radiographical CBD lymph node measurements may guide selection for performing laparoscopic staging with or without ultrasonography in conjunction with GDA nodal biopsy in patients with periampullary malignancy.

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Title: Impact of Regional Lymph Node Evaluation in Staging Patients With Periampullary Tumors
Authors: Shishir K. Maithel, MD
Korosh Khalili, MD
Elijah Dixon, MD
Maha Guindi, MD
Mark P. Callery, MD
Mark S. Cattral, MD
Bryce R. Taylor, MD
Steven Gallinger, MD
Paul D. Greig, MD
David R. Grant, MD
Charles M. Vollmer Jr., MD
Publication date: 01-01-2007
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 1/2007
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-006-9041-9

At a glance: The STEP trials

Springer Medicine

Impact of Regional Lymph Node Evaluation in Staging Patients With Periampullary Tumors

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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