title: Extracapsular lymph node spread as a negative prognostic factor of adenocarcinoma of the pancreas and cancer of the papilla of vater.
abstract: OBJECTIVE
  The aim of this study was to analyze the incidence and impact of extracapsular lymph node spread (ELNS) in pancreatic cancer (PC) and cancer of the papilla of Vater (CPV).
  
  
  METHODS
  Between 2004 and 2009, 148 patients underwent surgical therapy for PC (n = 112) and CPV (n = 36). The resected lymph nodes (LNs) were further analyzed for ELNS.
  
  
  RESULTS
  In 95 (64.2%) patients, LN metastasis was present. In 45 (47.3%) of these patients, an ELNS was present on histopathology. The patients' survival was negatively affected by ELNS. For PC, the 5-year survival rate was 37% for patients with no LN metastasis compared with 4% and 0% for patients with LN metastasis (pN1) but without extracapsular LN involvement and patients with pN1 disease with extracapsular LN involvement of at least 1 LN, respectively (P < 0.001). In patients with CPV, the 5-year survival rate was 56% for patients with no LN metastasis and 44% and 0% for patients with pN1 disease but without extracapsular LN involvement and patients with pN1 disease with extracapsular LN involvement of at least 1 LN, respectively (P = 0.006). Multivariate analysis revealed ELNS as an independent prognostic factor of survival for both tumor types.
  
  
  CONCLUSIONS
  Extracapsular LN spread is an independent negative prognostic factor in PC and CPV. In future staging systems, ELNS should be included.
authors.affiliation: From the Department of General, Visceral and Cancer Surgery, and Institute of Pathology, University of Cologne, Cologne, Germany.
authors.forename: Klaus L
authors.initials: KL
authors.lastname: Prenzel
authors.forename: Arnulf H
authors.initials: AH
authors.lastname: Hölscher
authors.forename: Uta
authors.initials: U
authors.lastname: Drebber
authors.forename: Elfriede
authors.initials: E
authors.lastname: Bollschweiler
authors.forename: Christian A
authors.initials: CA
authors.lastname: Gutschow
authors.forename: Dirk L
authors.initials: DL
authors.lastname: Stippel
authors.forename: Stefan P
authors.initials: SP
authors.lastname: Mönig
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000368:Aged; D014670:Ampulla of Vater; D003138:Common Bile Duct Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome