title: Prognostic value of lymph node metastases detected during surgical exploration for pancreatic or periampullary cancer: a systematic review and meta-analysis.
abstract: Hepatic-artery and para-aortic lymph node metastases (LNM) may be detected during surgical exploration for pancreatic (PDAC) or periampullary cancer. Some surgeons will continue the resection while others abort the exploration.
  
  
  
  A systematic search was performed in PubMed, EMBASE and Cochrane Library for studies investigating survival in patients with intra-operatively detected hepatic-artery or para-aortic LNM. Survival was stratified for node positive (N1) disease.
  
  
  
  After screening 3088 studies, 13 studies with 2045 patients undergoing pancreatoduodenectomy were included. No study reported survival data after detection of LNM and aborted surgical exploration. In 110 patients with hepatic-artery LNM, median survival ranged between 7 and 17 months. Estimated pooled mean survival in 84 patients with hepatic-artery LNM was 15 [95%CI 12-18] months (13 months in PDAC), compared to 19 [16-22] months in 270 patients with N1-disease without hepatic-artery LNM (p = 0.020). In 192 patients with para-aortic LNM, median survival ranged between 5 and 32 months. Estimated pooled mean survival in 169 patients with para-aortic LNM was 13 [8-17] months (11 months in PDAC), compared to 17 (6-27) months in 506 patients with N1-disease without para-aortic LNM (p < 0.001). Data on the impact of (neo)adjuvant therapy on survival were lacking.
  
  
  
  Survival after pancreatoduodenectomy in patients with intra-operatively detected hepatic-artery and especially para-aortic LNM is inferior to patients undergoing pancreatoduodenectomy with other N1 disease. It remains unclear what the consequence of this should be since data on (neo-)adjuvant therapy and survival after aborted exploration are lacking.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Lennart B
authors.initials: LB
authors.lastname: van Rijssen
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Poorvi
authors.initials: P
authors.lastname: Narwade
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Nadine C M
authors.initials: NC
authors.lastname: van Huijgevoort
authors.affiliation: Department of Surgery, Utrecht Medical Center, Utrecht, Netherlands.
authors.forename: Dorine S J
authors.initials: DS
authors.lastname: Tseng
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, Netherlands; Department of Surgery, St. Antonius Hospital, Nieuwegein, Netherlands.
authors.forename: Hjalmar C
authors.initials: HC
authors.lastname: van Santvoort
authors.affiliation: Department of Surgery, Utrecht Medical Center, Utrecht, Netherlands.
authors.forename: Isaac Q
authors.initials: IQ
authors.lastname: Molenaar
authors.affiliation: Department of Medical Oncology, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Hanneke W M
authors.initials: HW
authors.lastname: van Laarhoven
authors.affiliation: Department of Surgery, Erasmus Medical Center, Rotterdam, Netherlands.
authors.forename: Casper H J
authors.initials: CH
authors.lastname: van Eijck
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Olivier R C
authors.initials: OR
authors.lastname: Busch
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, Netherlands. Electronic address: m.g.besselink@amc.nl.
authors.forename: Marc G H
authors.initials: MG
authors.lastname: Besselink
mesh_terms: D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006499:Hepatic Artery / Q000473:pathology / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome