Background: This study investigated the prognostic impact of the exact location of nodal metastases in a subgroup of patients who underwent pancreatectomy with extended lymphadenectomy for head adenocarcinoma, with a special focus on station 16b1. Methods: Clinical, pathologic, and follow-up details were extracted from our database and analyzed retrospectively. Survival analysis was performed using univariate and multivariate models. We also performed a matched case-control analysis with resected patients who did not receive extended lymphadenectomy and with locally advanced patients. Results: The study population consisted of 67 patients. The rate of station 16b1 metastases was 20.9 %. Station 14a-b metastases (OR = 4.28), G3 tumors (OR = 4.03), and number of PLN ≥ 8 (OR = 4.46) were independently associated with station 16b1 involvement. Among pN1 patients, station 14a-b (HR = 2.60) and station 16b1 metastases (HR = 2.40) were predictors of survival. The median disease-specific survival of 16b1+ patients was 17 months (95 % CI 8.47–25.52). In the matched case-control analysis, the survival rates of resected 16b1+ patients was in between pN1/16b1− patients and locally advanced patients. Conclusions: Metastases to station 16b1 are associated with a decreased survival in comparison with pN1/16b1− patients, yet longer than in matched locally advanced patients. Station 14 can be considered as a “junctional node” to station 16b1.

Pancreatectomy with Para-Aortic Lymph Node Dissection for Pancreatic Head Adenocarcinoma: Pattern of Nodal Metastasis Spread and Analysis of Prognostic Factors

PAIELLA, SALVATORE;MALLEO, Giuseppe;Maggino, Laura;BASSI, Claudio;SALVIA, Roberto;BUTTURINI, Giovanni
2015-01-01

Abstract

Background: This study investigated the prognostic impact of the exact location of nodal metastases in a subgroup of patients who underwent pancreatectomy with extended lymphadenectomy for head adenocarcinoma, with a special focus on station 16b1. Methods: Clinical, pathologic, and follow-up details were extracted from our database and analyzed retrospectively. Survival analysis was performed using univariate and multivariate models. We also performed a matched case-control analysis with resected patients who did not receive extended lymphadenectomy and with locally advanced patients. Results: The study population consisted of 67 patients. The rate of station 16b1 metastases was 20.9 %. Station 14a-b metastases (OR = 4.28), G3 tumors (OR = 4.03), and number of PLN ≥ 8 (OR = 4.46) were independently associated with station 16b1 involvement. Among pN1 patients, station 14a-b (HR = 2.60) and station 16b1 metastases (HR = 2.40) were predictors of survival. The median disease-specific survival of 16b1+ patients was 17 months (95 % CI 8.47–25.52). In the matched case-control analysis, the survival rates of resected 16b1+ patients was in between pN1/16b1− patients and locally advanced patients. Conclusions: Metastases to station 16b1 are associated with a decreased survival in comparison with pN1/16b1− patients, yet longer than in matched locally advanced patients. Station 14 can be considered as a “junctional node” to station 16b1.
2015
Adenocarcinoma; Adult; Aged; Aorta; Case-Control Studies; Female; Humans; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Pancreatectomy; Pancreatic Neoplasms; Prognosis; Retrospective Studies; Survival Analysis; Survival Rate; Lymph Node Excision
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11562/960514
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