【Abstract】
Objectives: Pancreaticoduodenectomy (PD) followed by lymphadenectomy is performed for patients with pancreatic ductal adenocarcinoma (PDAC) located in the head of the pancreas. Since the head of the pancreas could be divided into dorsal or ventral primordium in relation to embryonic development, the metastasis of lymph node (LN) may differ. In this retrospective study, we evaluated the impact of extended or standard LN dissection for PDAC located in ventral or dorsal primordia of the pancreatic head.
Methods: From February 2016 to November 2018, 178 patients underwent PD for PDAC were enrolled at Pancreatic disease center, Ruijin Hospital Shanghai Jiaotong University School of Medicine. According to the tumor location and the range of LN dissection, all patients were divided into 3 groups: ventral primordium with extended lymphadenectomy (VE group), ventral primordium with standard lymphadenectomy (VS group) and dorsal primordium with extended lymphadenectomy (DE group). Clinical and pathological features were retrospectively analyzed, as well as the long-term survival outcomes.
Results: More patients in VE group were detected with metastasis in lymph nodes around superior mesenteric artery (LN14) than those in DE group (LN along right side of superior mesenteric artery (LN14ab): 22.9% vs 5.9%, p=0.005; (LN along left side of superior mesenteric artery (LN14cd): 10.0% vs 0.0%, p=0.022). LN14 was involved in more patients in VE group than in VS group (22.9% vs 5.0%, p=0.015). For IIb stage patients in VE group, the overall survival time (18.3 months vs 9.3 months, p＜0.001) and disease-free survival time (12.2 months vs 5.1 months, p=0.045) were longer in those with LN14cd (-) than those with LN14cd (+).
Conclusion: This study suggested that patients with PDAC located in the ventral head of the pancreas had higher risk of LN14 involvement compared with those at dorsal. Thus a thorough dissection of LN14 in PDAC located in the ventral head of the pancreas is recommended to optimize the regional extended lymphadenectomy.
【中文摘要】
背景：胰十二指腸切除術輔以區域淋巴結清掃是目前治療胰頭導管腺癌的手術方式。考慮到胰頭淋巴結回流與胰頭胚胎發育來源有關，本研究就不同胚胎來源的胰頭腫瘤是否需要對轉移率較高的淋巴結部位徹底清掃展開回顧性研究。
方法： 本研究收集自2016年2月至2018年11月，共計178名在上海交通大學醫學院附屬瑞金醫院胰腺中心接受根治性胰十二指腸切除術的胰頭導管腺癌患者。根據術前CT判斷胰頭腫瘤的胚胎發育來源以及術中淋巴結清掃方式將患者劃分為70名腹側胰頭癌擴大淋巴結清掃組（以下簡稱腹側擴大），68名背側胰頭癌擴大淋巴結清掃組（以下簡稱背側擴大）以及40名腹側胰頭癌標準淋巴結清掃組（以下簡稱腹側標準）。分析比較患者術前指標，術後病理結果、腫瘤復發以及患者生存情況。
結果：腹側擴大組患者較背側擴大組患者出現腸繫膜上動脈周圍淋巴結（即第14組淋巴結）轉移的比例更高（14ab:22.9% vs 5.9%,p=0.005,14cd:10% vs 0.0%,p=0.022）。腹側擴大組患者較腹側標準組患者術後檢出第14組淋巴結陽性比例更高（22.9% vs 5.0%, p=0.015）。經過至少一年的隨訪，IIb期腹側胰頭癌患者中未出現第14cd組淋巴結轉移較出現14cd組淋巴結轉移的患者總體生存時間（9.25個月vs18.3個月，p=0.000）和不帶瘤生存時間更長（12.2個月vs5.1個月，p=0.045）。
結論：本回顧性研究認為對未發生遠處轉移的可切除性腹側胰頭導管腺癌患者，在進行根治術胰十二指腸切除術輔以淋巴結清掃的過程中，應對腸繫膜上動脈周圍淋巴結進行徹底清掃。