Published online Nov 27, 2022. doi: 10.4240/wjgs.v14.i11.1204
Peer-review started: July 4, 2022
First decision: July 31, 2022
Revised: August 27, 2022
Accepted: October 12, 2022
Article in press: October 12, 2022
Published online: November 27, 2022
As the lymph-node metastasis rate and sites vary among pancreatic head carcinomas (PHCs) of different T stages, selective extended lymphadenectomy (ELD) performance may improve the prognosis of patients with PHC.
To investigate the effect of ELD on the long-term prognosis of patients with PHC of different T stages.
We analyzed data from 216 patients with PHC who underwent surgery at our hospital between January 2011 and December 2021. The patients were divided into extended and standard lymphadenectomy (SLD) groups according to extent of lymphadenectomy and into T1, T2, and T3 groups according to the 8th edition of the American Joint Committee on Cancer’s staging system. Perioperative data and prognoses were compared among groups. Risk factors associated with prognoses were identified through univariate and multivariate analyses.
The 1-, 2- and 3-year overall survival (OS) rates in the extended and SLD groups were 69.0%, 39.5%, and 26.8% and 55.1%, 32.6%, and 22.1%, respectively (P = 0.073). The 1-, 2- and 3-year disease-free survival rates in the extended and SLD groups of patients with stage-T3 PHC were 50.3%, 25.1%, and 15.1% and 22.1%, 1.7%, and 0%, respectively (P = 0.025); the corresponding OS rates were 65.3%, 38.1%, and 21.8% and 36.1%, 7.5%, and 0%, respectively (P = 0.073). Multivariate analysis indicated that portal vein invasion and lymphadenectomy extent were risk factors for prognosis in patients with stage-T3 PHC.
ELD may improve the prognosis of patients with stage-T3 PHC and may be of benefit if performed selectively.
Core Tip: Since the lymph node metastasis rate and site differ in pancreatic head carcinoma(PHC) patients at different T stage, we hypothesized that selectively performing extended lymphadenectomy (ELD) can improve the outcome of surgical treatment in PHC patients. The result confirmed that proceeding ELD in T3 stage PHC patients can increase long-term prognosis, providing a new idea to optimized the surgical procedure of PHC. Therefore we concluded that it may be beneficial to perform ELD in PHC patients at T3 stage and potentially increase the clinical outcome of these patients.