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
Pancreatic head carcinoma (PHC) is a highly malignant tumor, and radical surgery is the only potential curative treatment. However, the long-term postoperative prognosis remains unsatisfactory. As lymph-node metastasis is commonly seen in patients with PHC and has been identified as an independent prognostic factor for postoperative prognosis, extended lymphadenectomy (ELD) has been proposed for the resection of potentially invaded lymph nodes and improvement of the surgical outcome. However, no such improvement in prognosis has been observed. The PHC lymph-node metastasis rate correlates with the T stage, and selective ELD performance for advanced T-stage cases may improve the long-term prognosis.
Given the increases in the lymph-node metastasis rate and sites in patients with PHC, particularly that of advanced T stage, selective ELD performance for patients with advanced T-stage PHC may enable the elimination of more potentially invaded lymph nodes and improvement of the postoperative prognosis.
The objective of this study was to assess the therapeutic effect of ELD in patients with PHC of different T stages.
We retrospectively analyzed data from 216 patients diagnosed with pancreatic ductal adenocarcinoma who underwent surgical treatment at Beijing Chaoyang Hospital between January 2011 and December 2021. The patients were allocated to T1, T2, and T3 groups according to the 8th edition of the American Joint Committee on Cancer’s staging manual and divided into ELD and standard lymphadenectomy (SLD) groups according to the intraoperative extent of lymphadenectomy. Perioperative data and prognoses were compared between the ELD and SLD groups at the T1, T2, and T3 stages, and univariate and multivariate analyses were performed to identify risk factors.
The 1-, 2-, and 3-year disease-free survival (DFS) rates in the ELD and SLD groups were 59.9%, 32.1%, and 20.7% and 53.8%, 34.6%, and 16.7%, respectively (P = 0.227); corresponding overall survival (OS) rates 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 DFS rates for patients with stage-T3 PHC in the ELD and SLD groups were 50.3%, 25.1%, and 15.1% and 22.1%, 1.7%, and 0%, respectively (P = 0.025); corresponding OS rates were 65.3%, 38.1%, and 21.8% and 36.1%, 7.5%, and 0%, respectively (P = 0.005). Multivariate analysis indicated that portal vein invasion and lymphadenectomy extent were risk factors affecting the prognosis of patients with stage-T3 PHC.
Our research confirmed that ELD can be performed safely for PHC. Although ELD may not improve the overall prognosis of patients with PHC, its selective performance in patients with stage-T3 PHC may improve the long-term postoperative prognosis.
Several limitations of this study must be recognized. First, it was a single-center retrospective study; our findings need to be verified in multicenter prospective studies. Second, the stage-T3 SLD and ELD groups differed in age, which may have confounded our results; further research with more balanced samples is needed. As ELD increases the retrieved land positive lymph node counts, it may enable more accurate N staging, which may aid decision making about postoperative adjuvant therapy; further research on this possibility is needed.