Incidence and prognostic impact of para-aortic lymph nodes metastases during pancreaticoduodenectomy for peri-ampullary cancer.
BACKGROUND
Standard lymphadenectomy during pancreaticoduodenectomy (PD) for peri-ampullary cancer does not include the routine removal of para-aortic lymph nodes (PALN) (station 16, according to the JPS staging system). The aim of this study was to report the incidence and the prognostic value of PALN metastases in patients undergoing PD for peri-ampullary cancer.


METHODS
One hundred thirty-five consecutive patients who underwent PD and PALN dissection for peri-ampullary cancer were prospectively evaluated. The relationship between clinicopathological factors, including PALN metastases and survival was evaluated at univariate and multivariate analysis.


RESULTS
PALN metastases (N16+) were found in 11.1% of cases. At univariate analysis, R1 resection, metastatic nodes different from para aortic (N1) and N16+ significantly affected patients' prognosis. Compared with N16+, the median overall survival (OS) of N0 patients was significantly longer (32 versus 69 months, respectively; P < 0.05), whereas no difference was found between N16+ and N1 patients (32 versus 34 months, respectively) (P > 0.05). At multivariate analysis, only R1 resection reached statistical significance and was confirmed an independent prognostic factor.


CONCLUSIONS
Neoplastic involvement of PALN in peri-ampullary cancer is frequent and, so, their removal during PD could be justified. Moreover, PALN metastases should be not considered an absolute contraindication to radical surgery.
Department of General Surgery, Campus Bio-Medico University of Rome, Rome, Italy.
Gennaro
G
Nappo
Department of General Surgery, Campus Bio-Medico University of Rome, Rome, Italy.
Domenico
D
Borzomati
Unit of Pathology, Campus Bio-Medico University of Rome, Rome, Italy.
Giuseppe
G
Perrone
Department of General Surgery, Campus Bio-Medico University of Rome, Rome, Italy.
Sergio
S
Valeri
Unit of Pathology, Campus Bio-Medico University of Rome, Rome, Italy.
Michela
M
Amato
Public Health and Statistics, Campus Bio-Medico University of Rome, Rome, Italy.
Tommasangelo
T
Petitti
Department of General Surgery, Campus Bio-Medico University of Rome, Rome, Italy.
Roberto
R
Coppola
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal; D004379:Duodenal Neoplasms / Q000453:epidemiology / Q000556:secondary* / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D007432:Intraoperative Period; D007558:Italy / Q000453:epidemiology; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011379:Prognosis; D015996:Survival Rate / Q000639:trends