The principle and significance of lymphadenectomy in pancreaticoduodenectomy

Abstract

Lymph node metastasis occurs in early period, which is one of the important reasons for short survival and low 5-year survival rate of patients with pancreatic cancer. The curative surgical margin (R0) and complete clearance of regional lymph nodes could contribute to the improvement of survival. Standard lymphadenectomy for pancreatoduodenectomy should include No.5, 6, 8a, 12b1, 12b2, 12c, 13a, 13b, 14a, 14b, 17a, and 17b stations. However, the survival benefit of extended lymphadenectomy during pancreatectomy remain controversial, and there is no true definition of the optimal extent of lymphadenectomy. The controversy of extended lymphadenectomy focused on No.8 and 16 stations. There is a lot of evidence showed that no survival benefit could be achieved from lymphadenectomy of the left side of the superiormesenteric artery (SMA) and around the celiac trunk, splenic artery, and left gastric artery during pancreatoduodenectomy. Total mesopancreas excision could faciliate posterior clearance and R0 resection of pancreaticoduodenectomy in treating pancreatic head carcinoma. Total mesopancreas excision include the skeletonization on the right side of the SMA and CT at their origins, which is correspondent with partial No.16a2 lymphadenectomy. Therefore, D2 lymphadenectomy should be performed during pancreaticoduodenectomy to improve the survival of patients with pancreatic cancer. Key words: Pancreatic neoplasms; Laparoscopy; Pancreaticoduodenectomy; Lymph node excision