title: Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS).
abstract: BACKGROUND
  The lymph node (Ln) status of patients with resectable pancreatic ductal adenocarcinoma is an important predictor of survival. The survival benefit of extended lymphadenectomy during pancreatectomy is, however, disputed, and there is no true definition of the optimal extent of the lymphadenectomy. The aim of this study was to formulate a definition for standard lymphadenectomy during pancreatectomy.
  
  
  METHODS
  During a consensus meeting of the International Study Group on Pancreatic Surgery, pancreatic surgeons formulated a consensus statement based on available literature and their experience.
  
  
  RESULTS
  The nomenclature of the Japanese Pancreas Society was accepted by all participants. Extended lymphadenectomy during pancreatoduodenectomy with resection of Ln's along the left side of the superior mesenteric artery (SMA) and around the celiac trunk, splenic artery, or left gastric artery showed no survival benefit compared with a standard lymphadenectomy. No level I evidence was available on prognostic impact of positive para-aortic Ln's. Consensus was reached on selectively removing suspected Ln's outside the resection area for frozen section. No consensus was reached on continuing or terminating resection in cases where these nodes were positive.
  
  
  CONCLUSIONS
  Extended lymphadenectomy cannot be recommended. Standard lymphadenectomy for pancreatoduodenectomy should strive to resect Ln stations no. 5, 6, 8a, 12b1, 12b2, 12c, 13a, 13b, 14a, 14b, 17a, and 17b. For cancers of the body and tail of the pancreas, removal of stations 10, 11, and 18 is standard. Furthermore, lymphadenectomy is important for adequate nodal staging. Both pancreatic resection in relatively fit patients or nonresectional palliative treatment were accepted as acceptable treatment in cases of positive Ln's outside the resection plane. This consensus statement could serve as a guide for surgeons and researchers in future directives and new clinical studies.
authors: Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors: Johanna A M G
authors: JA
authors: Tol
authors: Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: D.J.Gouma@amc.nl.
authors: Dirk J
authors: DJ
authors: Gouma
authors: Department of Surgery and Oncology, Pancreas Institute, University of Verona, Verona, Italy.
authors: Claudio
authors: C
authors: Bassi
authors: Department of First Surgery, Agia Olga Hospital, Athens, Greece.
authors: Christos
authors: C
authors: Dervenis
authors: Department of General Surgery, Instituto Clinico Humanitas IRCCS, University of Milan, Milan, Italy.
authors: Marco
authors: M
authors: Montorsi
authors: Department of HPB Surgery, Hopital Edouard Herriot, Lyon, France.
authors: Mustapha
authors: M
authors: Adham
authors: Department of Surgery, Karolinska Institutet at Karolinska University Hospital, Huddinge, Stockholm, Sweden.
authors: Ake
authors: A
authors: Andrén-Sandberg
authors: Department of General Surgery, Mayo Clinic, Jacksonville, FL.
authors: Horacio J
authors: HJ
authors: Asbun
authors: Department of General-, Visceral- and Thoracic-Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors: Maximilian
authors: M
authors: Bockhorn
authors: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
authors: Markus W
authors: MW
authors: Büchler
authors: Professorial Surgical Unit, University of Dublin, Trinity College, Dublin, Ireland.
authors: Kevin C
authors: KC
authors: Conlon
authors: Department of Surgery, Clinic Hospital of Barcelona, University of Barcelona, Barcelona, Spain.
authors: Laureano
authors: L
authors: Fernández-Cruz
authors: First Department of Digestive Surgery, Hippokrateon Hospital, University of Athens, Athens, Greece; Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria.
authors: Abe
authors: A
authors: Fingerhut
authors: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors: Helmut
authors: H
authors: Friess
authors: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
authors: Werner
authors: W
authors: Hartwig
authors: Department of General-, Visceral- and Thoracic-Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors: Jakob R
authors: JR
authors: Izbicki
authors: Department of Surgery, Massachusetts General Hospital and the Harvard Medical School, Boston, MA.
authors: Keith D
authors: KD
authors: Lillemoe
authors: First Surgical Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia.
authors: Miroslav N
authors: MN
authors: Milicevic
authors: Department of Molecular and Clinical Cancer Medicine, Liverpool Cancer Research-UK Centre, University of Liverpool, Liverpool, UK.
authors: John P
authors: JP
authors: Neoptolemos
authors: Department of Gastrointestinal and HPB Surgical Oncology, Tata Memorial Hospital, Mumbai, India.
authors: Shailesh V
authors: SV
authors: Shrikhande
authors: Department of Surgery, Penn Medicine, The University of Pennsylvania, Philadelphia, PA.
authors: Charles M
authors: CM
authors: Vollmer
authors: Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA.
authors: Charles J
authors: CJ
authors: Yeo
authors: Department of HPB & Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK.
authors: Richard M
authors: RM
authors: Charnley
mesh_terms: D021441:Carcinoma, Pancreatic Ductal / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods / Q000592:standards*; D010180:Pancreatectomy / Q000379:methods / Q000592:standards*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods / Q000592:standards