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01-02-2020 | Pancreatectomy | Original Article

Role of lymphadenectomy, adjuvant chemotherapy, and treatment at high-volume centers in patients with resected pancreatic cancer—a distinct view on lymph node yield

Authors: Rene Warschkow, Catherine Tsai, Nastassja Köhn, Suna Erdem, Bruno Schmied, Daniel P. Nussbaum, Beat Gloor, Sascha A. Müller, Dan Blazer III, Mathias Worni

Published in: Langenbeck's Archives of Surgery | Issue 1/2020

Abstract

Purpose

While the importance of lymphadenectomy is well-established for patients with resectable pancreatic cancer, its direct impact on survival in relation to other predictive factors is still ill-defined.

Methods

The National Cancer Data Base 2006–2015 was queried for patients with resected pancreatic adenocarcinoma (stage IA–IIB). Patients were dichotomized into the following two groups, those with 1–14 resected lymph nodes and those with ≥ 15. Optimal number of resected lymph nodes and the effect of lymphadenectomy on survival were assessed using various statistical modeling techniques. Mediation analysis was performed to differentiate the direct and indirect effect of lymph node resection on survival.

Results

A total of 21,912 patients were included; median age was 66 years (IQR 59–73), 48.9% were female. Median number of resected lymph nodes was 15 (IQR 10–22), 10,163 (46.4%) had 1–14 and 11,749 (53.6%) had ≥ 15 lymph nodes retrieved. Lymph node positivity increased by 4.1% per lymph node up to eight examined lymph nodes, and by 0.6% per lymph node above eight. Five-year overall survival was 17.9%. Overall survival was better in the ≥ 15 lymph node group (adjusted HR 0.91, CI 0.88–0.95, p < 0.001). On a continuous scale, survival improved with increasing LNs collected. Patients who underwent adjuvant chemotherapy and were treated at high-volume centers had improved overall survival compared with their counterparts (adjusted HR 0.59, CI 0.57–0.62, p < 0.001; adjusted HR 0.86, CI 0.83–0.89, p < 0.001, respectively). Mediation analysis revealed that lymphadenectomy had only 18% direct effect on improved overall survival, while 82% of its effect were mediated by other factors like treatment at high-volume hospitals and adjuvant chemotherapy.

Discussion

While higher number of resected lymph nodes increases lymph node positivity and is associated with better overall survival, most of the observed survival benefit is mediated by chemotherapy and treatment at high-volume centers.

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Title: Role of lymphadenectomy, adjuvant chemotherapy, and treatment at high-volume centers in patients with resected pancreatic cancer—a distinct view on lymph node yield
Authors: Rene Warschkow
Catherine Tsai
Nastassja Köhn
Suna Erdem
Bruno Schmied
Daniel P. Nussbaum
Beat Gloor
Sascha A. Müller
Dan Blazer III
Mathias Worni
Publication date: 01-02-2020
Publisher: Springer Berlin Heidelberg
Keywords: Pancreatectomy
Lymphadenectomy
Pancreatic Cancer
Pancreatic Cancer
Cytostatic Therapy
Published in: Langenbeck's Archives of Surgery / Issue 1/2020
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-020-01859-2

At a glance: The STEP trials

Springer Medicine

Role of lymphadenectomy, adjuvant chemotherapy, and treatment at high-volume centers in patients with resected pancreatic cancer—a distinct view on lymph node yield

Abstract

Purpose

Methods

Results

Discussion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Discussion

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