Pancreatic Body Cancer Research Articles

A locally advanced pancreatic body cancer presenting common bile duct invasion resected via distal pancreatectomy after gemcitabine plus nab-paclitaxel chemotherapy: A case report.

IntroductionThe locally advanced pancreatic cancer has been steadily recognized as a potentially curable disease by a combination of chemotherapy and surgery. The remarkable effect of advanced chemotherapy would help surgeons do a function-preserving operation for advanced pancreatic cancer.Presentation of caseA 73-year-old woman presenting with obstructive jaundice was diagnosed to have a 3-cm pancreatic body cancer invading the celiac axis (CA), superior mesenteric artery (SMA), portal/splenic vein confluence, and the common bile duct (CBD). A plastic internal stent tube was placed endoscopically. After 11 cycles (231 days) of a weekly doublet chemotherapy with 1000 mg/m2 of gemcitabine and 125 mg/m2 of albumin-bound paclitaxel, the tumor shrunk based on imaging done every four months during chemotherapy, with residual periarterial high-density area around CA and proximal SMA and the patient was referred for surgery. During the operation, the absence of cancer cells was confirmed at (1) the origin of the proper hepatic artery, gastroduodenal artery and the left gastric artery, and (2) pancreatic cut stump along the right border of the portal vein; thus, distal pancreatectomy with coeliac axis resection was done. The patient had postoperative adjuvant chemotherapy with 100 mg/day of tegafur/gimeracil/oteracil for half a year and is currently alive and well, without signs of recurrence and diabetes mellitus a year after surgery.DiscussionAlthough surgical techniques aimed at local radicality are important, especially for conversion surgery for locally advanced pancreatic cancer, surgeons should consider the balance between radicality, safety, and functional preservation of surgery.

Minimally invasive surgery versus open surgery in radical antegrade modular pancreatosplenectomy (RAMPS): a systematic review and meta-analysis

Background: Background: RAMPS was first reported in 2003 by Strasberg for the treatment of pancreatic body and tail cancer. Today, minimally invasive distal pancreatectomy can also be performed as a RAMPS procedure. Yet, the safety and efficacy of minimally invasive RAMPS (M-RAMPS) is still controversial. To assess whether M-RAMPS is beneficial in patients with pancreatic body and tail cancer compared with open RAMPS (O-RAMPS) in a systematic review and meta-analysis.

Minimally Invasive Surgery Versus Open Surgery in Radical Antegrade Modular Pancreatosplenectomy (RAMPS): A Systematic Review and Meta-Analysis

Introduction: RAMPS was first reported in 2003 by Strasberg for the treatment of pancreatic body and tail cancer. Today, minimally invasive distal pancreatectomy can also be performed as a RAMPS procedure. Yet, the safety and efficacy of minimally invasive RAMPS (M-RAMPS) is still controversial. Methods: Clinical trials comparing outcomes of M-RAMPS and O-RAMPS in patients with pancreatic body and tail cancer were sought systematically in MEDLINE, Web of Science and CENTRAL. Main outcomes were pancreatic fistula, delayed gastric emptying (DGE), overall postoperative complications, postoperative haemorrhage. Furthermore, operative time and length of hospital stay were assessed. Pooled results are presented as odds ratios (OR) or mean difference (MD) with 95% confidence interval (CI). Results: 6 observational studies with a total of 296 patients were included in the final analysis. The M-RAMPS group showed a longer operative time. (MD 18.07, 95% CI 3.68 to 32.47) compared to the O-RAMPS group. There were no significant differences regarding rate of pancreatic fistula (OR 1.55, 95% CI 0.85 to 2.83), DGE (OR 1.29, 95% CI 0.46 to 3.63), major postoperative complications (OR 0.96, 95% CI 0.36 to 2.53), postoperative haemorrhage (OR 0.87, 95% CI 0.20 to 3.74) and length of hospital stay (MD -1.58, 95% CI -4.22 to 1.07). Conclusions: This meta-analysis shows that M-RAMPS is a feasible procedure with comparable outcomes compared to O-RAMPS. Due to the longer operation time, it’s actual value cannot finally be assessed. Consequently, more evidence should be generated by high-quality clinical trials in the future.

Feasibility and Safety of Laparoscopic Radical Distal Pancreatosplenectomy in Advanced Pancreatic Body and/or Tail Cancer Following Neoadjuvant Chemotherapy

Introduction: We conducted comparison analysis between laparoscopic radical distal pancreatosplenectomy (DPS) and open DPS in advanced pancreatic body and tail cancer following neoadjuvant chemotherapy to prove safety and feasibility of laparoscopic method.

Common Hepatic Artery Embolization Is Unnecessary Procedure before DP CAR. Experience of 40 Surgeries without Reconstructions

Background: Distal pancreatectomy with celiac artery(CA) resection(DPCAR) is an option for borderline resectable pancreatic body cancer. It is believed that reduction of arterial blood supply after DPCAR may cause severe liver ischemia. The decision to embolize preoperatively or reconstruct a common hepatic artery(СHA) during DPCAR is under discussion.

Radiological tumour invasion of splenic artery or vein in patients with pancreatic body or tail adenocarcinoma and effect on recurrence and survival.

Major vessel invasion is an important factor for determining the surgical approach and long-term prognosis for patients with pancreatic head cancer. However, clinical implications of vessel invasion have seldom been reported in pancreatic body or tail cancer. This study aimed to evaluate the clinical relevance of splenic vessel invasion with pancreatic body or tail cancer compared with no invasion and investigate prognostic factors. This study enrolled patients who underwent upfront distal pancreatectomy from 2005 to 2018. The circular degree of splenic vessel invasion was investigated and categorized into three groups (group 1, no invasion; group 2, 0-180°; group 3, 180° or more). Clinicopathological variables and perioperative and survival outcomes were evaluated, and multivariable Cox proportional analysis was performed to evaluate prognostic factors. Among 249 enrolled patients, tumour size was larger in patients with splenic vessel invasion (3.9 versus 2.9 cm, P = 0.001), but the number of metastatic lymph nodes was comparable to that in patients with no vessel invasion (1.7 versus 1.4, P = 0.241). The 5-year overall survival rates differed significantly between the three groups (group 1, 38.4 per cent; group 2, 16.8 per cent; group 3, 9.7 per cent, P < 0.001). Patients with both splenic artery and vein invasion had lower 5-year overall survival rates than those with one vessel (7.5 versus 20.2 per cent, P = 0.021). Cox proportional analysis revealed adjuvant treatment, R0 resection and splenic artery invasion as independent prognostic factors for adverse outcomes in pancreatic body or tail cancer. Splenic vessel invasion was associated with higher recurrence and lower overall survival in pancreatic body or tail cancers suggesting a need for a neoadjuvant approach.

Clinical dilemma of endoscopic ultrasound-guided fine needle aspiration for resectable pancreatic body and tail cancer.

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a first-line procedure for definitive tissue diagnosis of pancreatic cancer because of its high accuracy and low complication rate. The overall sensitivity of EUS-FNA for the diagnosis of pancreatic cancer is approximately 90%; however, its diagnostic ability for small lesions (<10 mm) remains limited. Although EUS-FNA is a relatively safe procedure, with an overall morbidity of ≤2%, it should be noted that needle tract seeding (NTS) can occur after EUS-FNA, which may affect the patient prognosis negatively. In patients with resected pancreatic tumors, preoperative EUS-FNA is not associated with an increased risk of postoperative recurrence. However, NTS after EUS-FNA for resectable pancreatic body and tail cancer has been highlighted recently, particularly by Japanese endoscopists. Thus, the use of preoperative EUS-FNA for the diagnosis of resectable pancreatic body and tail cancer has become a clinical dilemma that challenges gastroenterologists and must be carefully considered on a case-by-case basis by weighing the benefits and risks. This review summarizes the pros and cons of performing EUS-FNA in patients with resectable pancreatic body and tail cancer and provides valuable insight for gastroenterologists treating pancreatic cancer.

Robotic Radical Antegrade Modular Pancreatosplenectomy Using the Supracolic Anterior Superior Mesenteric Artery Approach

BackgroundRadical antegrade modular pancreatosplenectomy (RAMPS) is the standardized approach in open pancreatic resection for pancreatic body and tail cancer. However, few studies have described regarding robotic RAMPS for pancreatic cancer. We herein present our techniques of robotic RAMPS using the supracolic anterior superior mesenteric artery (SMA) approach with the ventral view. MethodsThe patient was a 75-year-old female with a diagnosis of pancreatic body cancer. Following neoadjuvant chemotherapy with gemcitabine plus nab-paclitaxel, robotic RAMPS was performed. Our techniques of robotic RAMPS include four steps: (1) gastrocolic ligament division, (2) dissection of superior and inferior border of the pancreas, (3) division of the pancreas, and (4) retroperitoneal dissection. ResultsThe operative time was 251 min with an estimated blood loss of 10 mL. The uneventful postoperative course was observed. The final pathology confirmed R0 surgical resection. ConclusionsRobotic RAMPS using the supracolic anterior SMA approach is safe and feasible for pancreatic body and tail cancer. Standardization and precise anatomical knowledge are key elements of performing robotic RAMPS.

Predictive Values of Preoperative Markers for Resectable Pancreatic Body and Tail Cancer Determined by MDCT to Detect Occult Metastases.

To evaluate the clinical value of preoperative markers in predicting occult metastases in resectable pancreatic body and tail cancer judged by a recent multidetector computed tomography (MDCT) scan of the abdomen. The data from a retrospective collected database from 2010 to 2019 with 699 patients who had MDCT scan predicted resectable mass in pancreatic body and tail and were pathological confirmed as adenocarcinoma after surgery. Receiver operating characteristic (ROC) curve was plotted for serum CA19-9, CA125, CEA and tumor size measured by MDCT. The optimal cut-off point-related sensitivity and specificity were calculated, respectively. Occult metastases were found in 73 (73/699, 10.4%) pancreatic body and tail cancer patients underwent exploration. The area under curve (AUC) for CA19-9, CA125, CEA and tumor size were 0.624, 0.733, 0.561 and 0.697, respectively. The optimal cut-off for CA19-9, CA125 and tumor size is 226 U/ml, 22.1 U/ml and 3.3cm, respectively. The sensitivity and specificity of CA19-9 for predicting occult metastases were 67.1% and 60.4%, 72.6% and 64.7% for CA125, 80.8% and 51.4% for tumor size. CA125 is superior to CA19-9 and tumor size for predicting occulting metastases in MDCT scan suggested resectable pancreatic body and tail cancer. The high level of CA125 (≥ 22.1 U/ml) is regarded as high risk for occulting metastases, and laparoscopy should be applied for these patients.

Surgical spacer placement for proton radiotherapy in locally advanced pancreatic body and tail cancers: initial clinical results

BackgroundParticle radiotherapy has increasingly gained acceptance for locally advanced pancreatic cancers owing to superior tumor conformity and dosimetry compared to conventional photon radiotherapy. However, the close proximity of the pancreas to the stomach and duodenum leads to radiation-induced gastrointestinal toxicities, which hinder the delivery of curative doses to the tumor. To overcome this problem, a surgical spacer was placed between the tumor and gastrointestinal tract, and subsequent proton radiotherapy was performed in this study.MethodsData from 9 patients who underwent surgical spacer placement and subsequent proton radiotherapy were analyzed. The safety and feasibility of the spacer placement surgery were evaluated; the impact of the spacer on dosimetry was also assessed using dose volume histogram (DVH) analyses, before and after surgical spacer placement.ResultsSurgical spacer placement and subsequent proton radiotherapy were successfully completed in all cases. Surgical spacer placement significantly improved the dose intensity covering 95%, mean, and minimum doses for the gross tumor volume, and the clinical and planning target volume based on the DVH, while respecting the dose constraints of the gastrointestinal tract. Based on the Common Terminology Criteria for Adverse Events, two patients (22.2%) developed gastrointestinal ulcer (Grade 2) at 1 and 35 months, and one patient (11.1%) developed gastric perforation (Grade 4) at 4 months after proton radiotherapy.ConclusionsSurgical spacer placement in the locally advanced pancreatic body and tail cancers is relatively safe and technically feasible. Comparing radiation plans, surgical spacer placement seems to improve the dose distribution in the locally advanced pancreatic body and tail cancers, which are close to the gastrointestinal tract.

Outcomes after distal pancreatectomy with celiac axis resection for pancreatic cancer: a single center retrospective study

Introduction: As distal pancreatectomy with celiac axis resection (DP-CAR) is the only possible cure for pancreatic body and tail cancer with celiac axis involvement, we performed this study to show the post-operative outcomes of DP-CAR. Method: 48 patients with pancreatic body and tail cancer with celiac axis involvement who underwent DP-CAR in Asan medical center between January 2008 and December 2018 were included in the study. We retrospectively reviewed the patient's preoperative, operative and postoperative data. Primary outcome was major morbidity and 90-day mortality, and secondary outcome was overall survival. Results: Major morbidity occurred in 9 patients (18.8%). 13 patients (27.1%) had pancreatic fistula grade B or C according to ISGPS guideline. There was 1 case (2.1%) of 90-day mortality after operation. Kaplan-Meier estimated median overall survival was 25.0 months. Conclusions: DP-CAR is a good treatment option for cure in pancreatic body and tail cancer with celiac axis involvement without significant morbidity and mortality.

Functioning arterial or venous riolan arch in localized pancreatic cancer. how it can change tactics?

Background: CT are obligatory before pancreatic surgery. Discovery of functioning arterial or venous Riolan arch (FRA) can have substantial influence on tactics. Aim: To assess importance of FRA discloser for decision making before pancreatic surgery. Patients: Retrospective analysis of 554 patients' consecutive preoperative CT data revealed arterial(n2) and venous(n5) FRA in 7 cases. Modification of treatment were assessed. Results: Arterial FRA was found in pancreatic body cancer(n2). 1.atherosclerotic occlusion of CA and SMA with symptomatic abdominal ischemia; 2.tumor involved CA on the background of endoluminally unreсonstructable SMA occlusion. In the first case CA stenting before distal pancreatectomy eliminated symptoms fully. In the second case after FOLFIRINOXn12 R0 DPCAR without SMA reconstruction was done because of good collateral supply. Uneventful postop period, discharge on days 10 and 13. Venous FRA in all the cases of PDAC of the head±body were the sign of full block of all SMV tributaries and already formed outflow through the splenic(SV) and/or inferior mesenteric(IMV) vein. In all these cases efficient neoadjuvant therapy and venous FRA were the weighty argument for pancreatic resection. Thrice it was done without venous reconstruction, twice with IMV transposition in SV, once with SMA resection. Uneventful postop period, discharge on days 10-19. One patient died 44 month (distant mets), the second died 19 months disease-free (MI), others alive 21,18,13,12 and 11 months after treatment. Conclusion: Delineation of FRA before pancreatic surgery is the indication for tactics change: endovascular treatment for arterial FRA and more aggressive surgery in case of venous FRA.

Efficacy of Spacers in Radiation Therapy for Locally Advanced Pancreatic Cancer: A Planning Study.

We aimed to investigate the dosimetric effects of a spacer placed between the pancreas and surrounding gastrointestinal structures in intensity-modulated radiation therapy (IMRT) planning to provide more effective radiation therapy for locally advanced pancreatic cancer (LAPC). Treatment planning was performed for six patients with LAPC based on computed tomography images without spacers and with 5-mm or 10-mm spacers virtually inserted under the supervision of a hepatobiliary pancreatic surgeon. The prescription dose was 63 Gy in 28 fractions. With the exception of one case of pancreatic head cancer, planning target volume receiving ≥95% of the prescribed dose (PTV V95) was achieved by 90% or more by inserting a spacer, and by 95% or more in all 3 cases of pancreatic body and tail cancer by inserting a 10-mm spacer. IMRT with appropriate spacer placement may help provide high-dose treatment for LAPC and improve associated patient outcomes.

Laparoscopic distal pancreatectomy for benign and malignant disease: a review of techniques and results.

Diagnosis of pancreatic cancer is challenging in the initial phases because its progression is rapid. The pancreatic tail and body roughly accounts for 20–30% of all cancerous cases. The standard treatment for symptomatic benign, malignant, and premalignant diseases of the pancreatic tail and body is distal pancreatectomy. This technique has been modified over the years to fit certain indications, with the goal of enhancing post-operative results as well as reducing patient trauma. In cases of a premalignant and symptomatic benign condition, the spleen must be preserved either using Kimura’s splenic vessel preservation technique or Warshaw’s splenic vessel resection technique. A better long-term prognosis is ensured by regional lymph node dissection and radical R0 resection. Radical antegrade modular pancreatosplenectomy was proposed to tackle the shortcomings of traditional surgery for pancreatic tail and body cancer. In this review, study techniques and results of laparoscopic distal pancreatectomy for malignant and benign pancreatic ailments were described with the intention of providing knowledge on various suitable techniques reported for pancreatic cancer treatment. Furthermore, this study will serve as a ready reckoner for surgeons and could serve to boost their confidence levels during surgery by avoiding confusion on the selection of suitable for the pancreatic diseases diagnosed.

Common hepatic artery embolization is an unnecessary procedure before DP CAR. Experience of 40 surgeries without arterial reconstructions

Background: Distal pancreatectomy with celiac artery (CA) resection (DPCAR) is an option for borderline resectable pancreatic body cancer. It is believed that the reduction of arterial blood supply after DPCAR may cause severe liver ischemia. Decision to embolize preoperatively or reconstruct common hepatic artery (СHA) during DPCAR is under discussion. Aim: To assess postDPCAR events: Primary: liver arterial supply, arterial blood flow intensity (BFI) through the pancreaticoduodenal (PDA), gastroduodenal (GDA) and proper hepatic (PHA) arteries. Secondary: morbidity, 90-days mortality,pancreatic fistulas B/C, OS, DFS. Patients and methods: Arterial anatomy, diameters of CHA, PDA, GDA and PHA were registered before and after 40 DP CARs by CT. IOUS (40) and ICG–gastroscopy (10) were ischemia assessment tools. Preoperative CHA embolization was never used. Results: Among 52 CA resections 12 procedures were excluded because of GDA involvement and necessity for total duodenopancreatectomy/arterial reconstruction. In all 40 residuary cases of DPCAR arterial flow in liver parenchyma was preserved and there were no CHA reconstructions. GDA, PDA and PHA BFI increased in 0,71-90 times after DPCAR, BFI in PHA didn’t change significantly after surgery. Gastric ischemia was revealed in 4 and liver ischemia in 0 cases. R0 -resection was achieved in 36 (90%) cases. Chemotherapy for PDAC(31) was neoadjuvant (11) and adjuvant (16). Morbidity-57,5%, B/Cfistulas-8 (20%), mortality-3 (7,5%), OS-30 months, DFS-16 months, Three and 5-year survival were 83%,43% and 41%, Actual 5-y OS -19.5%. Conclusion: As CHA reconstruction, so as its preoperative occlusion are unnecessary procedures for DPCAR. IOUS is a reliable method for liver ischemia assessment during DPCAR, which is less frequent event than gastric ischemia.

ASO Author Reflections: Optimal Procedure of Surgical Resection for Pancreatic Body Cancer under Consideration of Significance of Peripancreatic Head Lymph Node Dissection.

ASO Author Reflections: Optimal Procedure of Surgical Resection for Pancreatic Body Cancer under Consideration of Significance of Peripancreatic Head Lymph Node Dissection.

Combined resection of the hepatic artery without reconstruction in pancreaticoduodenectomy: a case report of pancreatic cancer with an aberrant hepatic artery

BackgroundPancreaticoduodenectomy (PD) is rarely performed for pancreatic cancer with hepatic arterial invasion owing to its poor prognosis and high surgical risks. Although there has been a recent increase in the reports of PD combined with hepatic arterial resection due to improvements in disease prognosis and operative safety, PD with major arterial resection and reconstruction is still considered a challenging treatment.Case presentationA 61-year-old man with back pain was diagnosed with pancreatic head and body cancer. Although distant metastasis was not confirmed, the tumor had extensively invaded the hepatic artery; therefore, we diagnosed the patient with locally advanced unresectable pancreatic cancer. After gemcitabine plus nab-paclitaxel (GnP) therapy, the tumor considerably decreased in size from 35 to 20 mm. Magnetic resonance imaging revealed a gap between the tumor and the hepatic artery. Tumor marker levels returned to their normal range, and we decided to perform conversion surgery. In this case, an artery of liver segment 2 (A2) had branched from the left gastric artery; therefore, we decided to preserve A2 and perform PD combined with hepatic arterial resection without reconstruction. After four cycles of GnP therapy, we performed hepatic arterial embolization to prevent postoperative ischemic complications prior to surgery. Immediately after embolization, collateral arterial blood flow to the liver was observed. Operation was performed 19 days after embolization. Although there was a temporary increase in liver enzyme levels and an ischemic region was found near the surface of segment 8 of the liver after surgery, no liver abscess developed. The postoperative course was uneventful, and S-1 was administered for a year as adjuvant chemotherapy. The patient is currently alive without any ischemic liver events and cholangitis and has not experienced recurrence in the past 4 years since the surgery.ConclusionsIn PD for pancreatic cancer with hepatic arterial invasion, if a part of the hepatic artery is aberrant and can be preserved, combined resection of the common and proper hepatic artery without reconstruction might be feasible for both curability and safety.

Prognostic value of preoperative glucose to lymphocyte ratio in patients with resected pancreatic cancer.

Inflammatory factors and fasting blood glucose were verified to be associated with the prognosis of pancreatic ductal adenocarcinoma. The goal of this study is to confirm the prognostic role of preoperative blood glucose to lymphocyte ratio for patients with resected pancreatic ductal adenocarcinoma. A total of 259 pancreatic ductal adenocarcinoma patients were enrolled and randomly divided into training cohort and validation cohort. The training cohort was used to generate an optimal cutoff value and the validation cohort was used to further validate the model. A total of 259 patients were incorporated in this study and randomly divided into the training cohort (n = 130, 1/2 of 259) and the validation cohort (129, 1/2 of 259). The optimal cutoff value of glucose to lymphocyte ratio was calculated to be 3.47 for overall survival. Cox regression analysis found that preoperative blood glucose to lymphocyte ratio was independent risk factor (p = 0.040) for overall survival. Prognostic values of glucose to lymphocyte ratio on overall survival were observed in younger male patients with pancreatic body and tail cancer, American Joint Committee on Cancer 8th N1 stage, without microvascular and peripancreatic fat invasion, and Carbohydrate antigen 19-9 higher than 200 U/ml. A prognostic prediction model of overall survival was designed and presented in nomogram. Preoperative blood glucose to lymphocyte ratio is an independent biomarker to predict the overall survival for pancreatic ductal adenocarcinoma patients who underwent curative resection.

Treatment of Advanced Pancreatic Body and Tail Cancer by En Bloc Distal Pancreatectomy with Transverse Mesocolon Resection Using a Mesenteric Approach.

Pancreatic body and tail cancer easily invades retroperitoneal tissue, including the transverse mesocolon. It is difficult to ensure a dissected peripancreatic margin with standard distal pancreatectomy for advanced pancreatic body and tail cancer. Thus, we developed a novel surgical procedure to ensure dissection of the peripancreatic margin. This involved performing dissection deeper than the fusion fascia of Toldt and further extensive en bloc resection of the root of the transverse mesocolon. We performed distal pancreatectomy with transverse mesocolon resection (DP-TCR) using a mesenteric approach and achieved good outcomes. There are two main considerations for surgical procedures using a mesenteric approach: 1) dissection deeper than the fusion fascia of Toldt (securing the vertical margin) and 2) modular resection of the pancreatic body and tail, with the root of the transverse mesocolon and adjacent organs in a horizontal direction (ensuring the caudal margin). From 2017 to 2019, we performed DP-TCR using a mesenteric approach for six patients with advanced pancreatic body and tail cancer. Histopathological radical surgery was possible in all patients who underwent DP-TCR. No Clavien-Dindo grade IIIa or worse perioperative complications were observed in any patient. We believe that DP-TCR is useful as a radical surgery for advanced pancreatic body and tail cancer with extrapancreatic invasion.

Pancreatic body and tail cancer and favorable metastatic lymph node behavior on the left edge of the aorta

BackgroundLymph node (LN) metastasis in pancreatic body-tail cancer is a poor prognostic factor and the optimal LN dissection area for distal pancreatectomy (DP) remains unclear. Lymphatic flow from the tumors is thought to depend on the tumor sites. We examined LN metastasis frequency based on tumor site and recurrent patterns post-DP. MethodsWith a retrospective, single institutional study, we examined 100 patients who underwent DP as an upfront surgery for pancreatic cancer over 17 years. Tumor sites were classified as tumor confined to pancreatic body (and neck) (Pb(n)); and pancreatic tail (Pt). We compared metastatic LN and recurrence patterns based on tumor site. The median overall survival (OS) and disease-free survival (DFS) were analyzed. ResultsLN metastasis occurred in 59/100 (59.0%), with 23 and 25 tumors located in the Pb(n), and Pt, respectively. Those with the tumor in Pt had metastases to #10, #11d/p, and #18 LN mainly. However, the patients with the Pb(n) tumor had metastases to #8a/p, #11p, and #14p/d LN. There was no metastasis to #10 and #11d LN. The OS and DFS were 34 and 15 months, respectively. No significant difference was found in the OS, DFS, and recurrence patterns based on tumor sites. ConclusionDifferences in metastatic LN sites were observed in pancreatic body-tail cancer when tumors were confined to the left or right of the left aortic edge. Although it is necessary to validate this finding with a large-scale study, organ-preserving DP might be a treatment option for selected patients depending on the tumor sites.