Pancreaticoduodenectomy and standard lymphadenectomy in patients with pancreatic head adenocarcinoma

Abstract

Aims: This prospective study accessed the lymph node involvement in patients with resectable pancreatic head or uncinate process carcinoma undergoing pancreaticoduodenectomy (PD) with standard lymphadenectomy. Methods: Medical records of 116 consecutive patients treated for adenocarcinoma in the head or uncinate process of the pancreas at our clinic between January 2004 and December 2012 were analyzed. Patients underwent a classic Whipple’s procedure or pylorus preservation. For standard lymphadenectomy, node stations 12B1, 12B2, 12C, 17A, 17B, 13A, 13B, 14A, 14B and 8A were harvested. Results: Morbidity and mortality rate after PD were 44,8% (n = 52) and 5,1% (n = 6), respectively. The number of retrieved lymph nodes with standard lymphadenectomy was ≥15. Out of 116 patients, 81 (69.8%) were lymph-node positive. The lymph-node areas most affected were station 13 (n = 24), 17 (n = 17) and 14 (n = 13 each), 12 (n = 5) and 8A (n = 2) (P = 0,016). The lymph node involvement affected the rates of local recurrence, which occurred in 20 of 75 (26,6%) and in two of 35 (5,7%) patients with and without lymph-node involvement (P = 0,024). Regional nodal metastases from primary tumour correlated with the development of distant metastases (P = 0,011). Median disease-free survival from the date of surgery was 8,5 months (95% CI 6,4–18) in 75 patients with lymph-node metastases and 14,0 months (95% CI 11,1–18) in 35 patients without lymph-node metastases, respectively (P = 0,022). Median overall survival from the date of surgery was 12 months (95% CI 10.4-18) in 75 patients with lymph-node metastases and 17 months (95% CI 15,3–18) in 35 patients without lymph-node metastases, respectively (P = 0,035). Conclusions: PD with standard lymphadenectomy should be the procedure of choice in patients with pancreatic head adenocarcinoma. We establish a directly proportional correlation between the presence of metastatic lymph nodes independently of their number and the development of local recurrence and distant metastases.