Abstract
Simple SummaryAlthough the survival benefit of “regional lymph node dissection” for pancreatic head cancer remains unclear, the R0 resection rate is reportedly associated with prognosis. We reviewed the literature that could be helpful in determining the appropriate resection range. The recent development of high-quality computed tomography has made it possible to evaluate the extent of cancer infiltration. Even if the “dissection to achieve R0 resection” range is simulated based on the computed tomography evaluation, it is difficult to identify the range intraoperatively. It is necessary to be aware of the anatomical landmarks to determine the appropriate dissection range intraoperatively.Patients with resectable pancreatic cancer are considered to already have micro-distant metastasis, because most of the recurrence patterns postoperatively are distant metastases. Multimodal treatment dramatically improves prognosis; thus, micro-distant metastasis is considered to be controlled by chemotherapy. The survival benefit of “regional lymph node dissection” for pancreatic head cancer remains unclear. We reviewed the literature that could be helpful in determining the appropriate resection range. Regional lymph nodes with no suspected metastases on preoperative imaging may become areas treated with preoperative and postoperative adjuvant chemotherapy. Many studies have reported that the R0 resection rate is associated with prognosis. Thus, “dissection to achieve R0 resection” is required. The recent development of high-quality computed tomography has made it possible to evaluate the extent of cancer infiltration. Therefore, it is possible to simulate the dissection range to achieve R0 resection preoperatively. However, it is often difficult to distinguish between areas of inflammatory changes and cancer infiltration during resection. Even if the “dissection to achieve R0 resection” range is simulated based on the computed tomography evaluation, it is difficult to identify the range intraoperatively. It is necessary to be aware of anatomical landmarks to determine the appropriate dissection range during surgery.
Highlights
Pancreatic ductal adenocarcinoma (PDAC) is recognized as having one of the poorest prognoses of all tumors
Multimodal treatment is required to improve the prognosis of resectable pancreatic cancer, and pancreatic resection should be performed with consideration of preoperative and postoperative treatment
Many studies have described the need for R0 resection to achieve long-term survival, and the results of most studies have shown that R0 resection improves the survival rate of patients with resectable PDAC who have undergone pancreaticoduodenectomy (PD) [18,19]
Summary
Pancreatic ductal adenocarcinoma (PDAC) is recognized as having one of the poorest prognoses of all tumors. Several randomized controlled trials have shown that extended lymph node dissection does not provide survival benefits in patients with pancreatic head cancer, despite a prolonged operative time and increased blood loss [1,2,3,4,5]. Regional lymph node dissection for pancreatic head cancer has been performed in many facilities, but its survival benefit remains unclear. Pancreatic cancer treatment has dramatically changed recently owing to the development of effective chemotherapy. A randomized prospective study showed that the introduction of preoperative chemotherapy led to a prolonged prognosis in patients with pancreatic cancer [8]. Multimodal treatment is required to improve the prognosis of resectable pancreatic cancer, and pancreatic resection should be performed with consideration of preoperative and postoperative treatment. In the era of multidisciplinary treatment for resectable pancreatic cancer, we reviewed the literature that could be helpful in determining the appropriate resection range
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