Online citations, reference lists, and bibliographies.

Definition Of A Standard Lymphadenectomy In Surgery For Pancreatic Ductal Adenocarcinoma: A Consensus Statement By The International Study Group On Pancreatic Surgery (ISGPS).

Johanna A. Tol, Dirk Joan Gouma, Claudio Bassi, Christos G. Dervenis, Marco Montorsi, Mustapha Adham, Åke Andrén-Sandberg, Horacio J. Asbun, Maximilian Bockhorn, Markus W. Büchler, Kevin C. P. Conlon, Laureano Fernández‐Cruz, Abe L Fingerhut, Helmut Friess, Werner Hartwig, Jakob Robert Izbicki, Keith D. Lillemoe, Miroslav N Milićević, John P Neoptolemos, Shailesh V Shrikhande, Charles M. Vollmer, Charles J Yeo, Richard M. Charnley
Published 2014 · Medicine
Cite This
Download PDF
Analyze on Scholarcy
Share
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. CONCLUSION 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.
This paper references
10.1007/s11605-012-1853-2
Number of Lymph Nodes Evaluated: Prognostic Value in Pancreatic Adenocarcinoma
M. Huebner (2012)
10.1097/SLA.0b013e31821fd334
Pancreatic Cancer Surgery in the New Millennium: Better Prediction of Outcome
Werner Hartwig (2011)
10.1002/bjs.5716
Systematic review and meta-analysis of standard and extended lymphadenectomy in pancreaticoduodenectomy for pancreatic cancer.
Christoph W. Michalski (2007)
10.1159/000337306
Identification of the Lymphatic Drainage Pathways from the Pancreatic Head Guided by Indocyanine Green Fluorescence Imaging during Pancreaticoduodenectomy
Seiko Hirono (2012)
10.1007/s00534-011-0466-6
Standard versus extended lymphadenectomy in radical pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas
Yuji Nimura (2012)
10.1007/s00268-010-0577-2
Prognostic Impact of Para-aortic Lymph Node Metastasis in Pancreatic Ductal Adenocarcinoma
Yoshiaki Murakami (2010)
10.1007/s00268-011-1245-x
Distal Pancreatectomy with Celiac Axis Resection for Carcinoma of the Body and Tail of the Pancreas
Yu Takahashi (2011)
10.1016/j.surg.2006.12.013
Prognostic relevance of lymph node ratio following pancreaticoduodenectomy for pancreatic cancer.
T. Pawlik (2007)
10.1002/bjs.4761
Survival of patients with periampullary carcinoma is predicted by lymph node 8a but not by lymph node 16b1 status.
Saxon Connor (2004)
10.1097/SLA.0b013e3181d77369
Positive Mobilization Margins Alone Do Not Influence Survival Following Pancreatico-Duodenectomy for Pancreatic Ductal Adenocarcinoma
N B Jamieson (2010)
10.1007/s11605-009-0919-2
The Lymph Node Ratio is the Strongest Prognostic Factor after Resection of Pancreatic Cancer
H. Riediger (2009)
10.1016/j.surg.2005.02.009
Para-aortic lymph node metastasis in carcinoma of the head of the pancreas.
Mitsuru Sakai (2005)
10.1016/j.jamcollsurg.2011.10.008
Long-term results of resection of adenocarcinoma of the body and tail of the pancreas using radical antegrade modular pancreatosplenectomy procedure.
J. Mitchem (2012)
10.1097/01.mpa.0000235306.96486.2a
The Ratio of Metastatic/Resected Lymph Nodes is an Independent Prognostic Factor in Patients With Node-positive Pancreatic Head Cancer
Marek Sierzega (2006)
10.1159/000018744
A Surgical and Pathological Based Classification of Resective Treatment of Pancreatic Cancer
S. Pedrazzoli (1999)
10.1097/00000658-198808000-00014
Practical Usefulness of Lymphatic and Connective Tissue Clearance for the Carcinoma of the Pancreas Head
Osamu Ishikawa (1988)
10.1016/j.gassur.2005.08.034
Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinomad—part 3: Update on 5-year survival
T. Riall (2005)
10.1097/00000658-199905000-00003
Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short-term outcome.
C. Yeo (1999)
10.1046/j.1365-2168.1997.02754.x
Lymph node metastasis in carcinoma of the body and tail of the pancreas.
Akihide Nakao (1997)
10.1159/000018739
Standard Kausch-Whipple Pancreatoduodenectomy
Lucie Jones (1999)
10.1097/01.sla.0000258608.52615.5a
Distal Pancreatectomy With En Bloc Celiac Axis Resection for Locally Advanced Pancreatic Body Cancer: Long-term Results
S. Hirano (2007)
10.1001/archsurg.142.8.767
Accuracy of staging node-negative pancreas cancer: a potential quality measure.
James S Tomlinson (2007)
10.1159/000012131
Body Mass Index Determines the Success of Lymph Node Dissection and Predicts the Outcome of Gastric Carcinoma Patients
Dipok Kumar Dhar (2000)
The metastatic/examined lymph node ratio is an important prognostic factor after pancreaticoduodenectomy for pancreatic adenocarcinoma.
Adam C Berger (2004)
10.1007/s11605-007-0243-7
Prognostic Significance of Pathologic Nodal Status in Patients with Resected Pancreatic Cancer
Michael G. House (2007)
10.1002/1097-0142(19890901)64:5<1132::AID-CNCR2820640528>3.0.CO;2-V
Radical pancreatectomy for ductal cell carcinoma of the head of the pancreas.
T. Manabe (1989)
10.1097/00000658-200209000-00012
Pancreaticoduodenectomy With or Without Distal Gastrectomy and Extended Retroperitoneal Lymphadenectomy for Periampullary Adenocarcinoma, Part 2: Randomized Controlled Trial Evaluating Survival, Morbidity, and Mortality
C. Yeo (2002)
10.1016/j.jclinepi.2012.03.013
GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations.
Jeff Andrews (2013)
10.1007/s002689910089
Surgery for Ductal Adenocarcinoma of the Pancreatic Head: Staging, Complications, and Survival after Regional versus Extended Lymphadenectomy
Doris Henne-Bruns (2000)
10.1159/000051467
Modified Standard Pancreaticoduodenectomy for the Treatment of Pancreatic Head Cancer
Yoshifumi Kawarada (1999)
10.1245/s10434-012-2809-1
CA19-9 in Potentially Resectable Pancreatic Cancer: Perspective to Adjust Surgical and Perioperative Therapy
Werner Hartwig (2012)
10.1067/msy.2003.146
Radical antegrade modular pancreatosplenectomy.
S. Strasberg (2003)
10.2535/ofaj1936.77.6_189
Long descending lymphatic pathway from the pancreaticoduodenal region to the para-aortic nodes: its laterality and topographical relationship with the celiac plexus.
I. Hirai (2001)
Classification of pancreatic carcinoma
日本膵臓学会 (2003)
10.1097/MPA.0b013e3182148342
Pattern of Lymph Node Metastasis Spread in Pancreatic Cancer
Mitsuro Kanda (2011)
10.1097/MPA.0b013e318258055c
Japan Pancreatic Cancer Registry; 30th Year Anniversary: Japan Pancreas Society
S. Egawa (2012)
10.1007/s11605-010-1285-9
Does Body Mass Index/Morbid Obesity Influence Outcome in Patients Who Undergo Pancreatoduodenectomy for Pancreatic Adenocarcinoma?
Saboor Khan (2010)
Preoperative embolization of the common hepatic artery in preparation for radical pancreatectomy for pancreas body cancer.
Satoshi Kondo (2000)
10.1016/j.ejso.2008.01.002
A comparison of pancreaticoduodenectomy with extended pancreaticoduodenectomy: a meta-analysis of 1909 patients.
Nimra Iqbal (2009)
Preoperative embo- lization of the common hepatic artery in preparation for radical pancreatectomy for pancreas body cancer. Hepato- gastroenterology 2000;47:1447-9
S Kondo (2000)
10.1097/MPA.0b013e3181889e2d
Pancreatic Cancer With Paraaortic Lymph Node Metastasis: A Contraindication for Radical Surgery?
Suguru Yamada (2009)
10.1016/j.surg.2005.06.044
A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma.
M. Farnell (2005)
10.1097/00000658-199810000-00007
Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group.
S. Pedrazzoli (1998)
10.1007/s11605-012-1974-7
N0/N1, PNL, or LNR? The Effect of Lymph Node Number on Accurate Survival Prediction in Pancreatic Ductal Adenocarcinoma
Nakul P. Valsangkar (2012)
10.1245/s10434-007-9587-1
Impact of Total Lymph Node Count and Lymph Node Ratio on Staging and Survival after Pancreatectomy for Pancreatic Adenocarcinoma: A Large, Population-Based Analysis
Mark B. Slidell (2007)
10.1002/(SICI)1097-0142(19961215)78:12<2485::AID-CNCR6>3.0.CO;2-J
Lymphatic flow and neural plexus invasion associated with carcinoma of the body and tail of the pancreas.
Masato Kayahara (1996)
10.1097/MPA.0b013e3182207893
Prognostic Implications of Lymph Node Metastases in Carcinoma of the Body and Tail of the Pancreas
Tevfik Tolga Şahin (2011)
10.1245/s10434-006-9016-x
Extent of Lymph Node Retrieval and Pancreatic Cancer Survival: Information from a Large US Population Database
R. Schwarz (2006)



This paper is referenced by
10.1007/s00108-018-0460-z
Duktales Adenokarzinom des Pankreas
Eike Gallmeier (2018)
10.1016/j.surg.2015.12.024
Long-term survival in patients with pancreatic ductal adenocarcinoma.
Alexander P Stark (2016)
10.1002/bjs.10842
Validation of at least 1 mm as cut‐off for resection margins for pancreatic adenocarcinoma of the body and tail
Thomas P. Hank (2018)
10.1016/j.ejso.2020.04.006
Reappraisal of nodal staging and study of lymph node station involvement in distal pancreatectomy for body-tail pancreatic ductal adenocarcinoma.
Giuseppe Malleo (2020)
10.1007/s00464-019-06969-7
Laparoscopic versus open pancreaticoduodenectomy for pancreatic neuroendocrine tumors: a single-center experience
H. Kim (2019)
10.1590/0102-6720201700010012
Angiolymphatic invasion as a prognostic fator in resected N0 pancreatic adenocarcinoma
Ricardo Vitor Silva de ALMEIDA (2017)
10.1155/2019/6985703
Calprotectin and Calgranulin C as Biomarkers of Pancreatic Tumors: Baseline Levels and Level Changes after Surgery
Michal Holub (2019)
10.1016/j.dld.2020.02.011
Digestive Neuroendocrine Neoplasms (NEN): French Intergroup clinical practice guidelines for diagnosis, treatment and follow-up (SNFGE, GTE, RENATEN, TENPATH, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, SFR).
Louis de Mestier (2020)
10.1016/j.ejso.2016.10.023
Radical surgery of oligometastatic pancreatic cancer.
T Hackert (2017)
10.1097/SLA.0000000000001763
Multi-institutional Validation Study of the American Joint Commission on Cancer (8th Edition) Changes for T and N Staging in Patients With Pancreatic Adenocarcinoma
P. Allen (2017)
10.1016/j.surg.2015.01.003
Resection of the mesopancreas in pancreatic head adenocarcinoma: Is it outside of the International Study Group on Pancreatic Surgery definition and consensus statement for standard and extended pancreatectomy?
N Peparini (2015)
10.1007/s11605-016-3131-1
Para-Aortic Dissection in Pancreaticoduodenectomy with Mesopancreas Excision for Pancreatic Head Carcinoma: Not Only an N-Staging Matter
N Peparini (2016)
10.1097/SLA.0000000000003514
Permanent Pancreatic Duct Occlusion With Neoprene-based Glue Injection After Pancreatoduodenectomy at High Risk of Pancreatic Fistula
Vincenzo Mazzaferro (2019)
10.1245/s10434-020-08304-0
How to Approach Para-Aortic Lymph Node Metastases During Exploration for Suspected Periampullary Carcinoma: Resection or Bypass?
Bobby K. Pranger (2020)
10.1016/j.ijsu.2018.05.025
Evolution of pancreatectomy with en bloc venous resection for pancreatic cancer in Italy. Retrospective cohort study on 425 cases in 10 pancreatic referral units.
G. Nigri (2018)
10.1186/s13063-017-1892-9
Minimally invasive versus open distal pancreatectomy (LEOPARD): study protocol for a randomized controlled trial
T. de Rooij (2017)
10.1007/S10353-018-0535-Z
A comprehensive study of the mesopancreas as an extension of the pancreatic circumferential resection margin
Charlotte Maplanka (2018)
10.1016/j.surg.2017.05.016
Postoperative infections represent a major determinant of outcome after pancreaticoduodenectomy: Results from a high‐volume center
Matteo De Pastena (2017)
10.7150/jca.21341
Total mesopancreas excision for the treatment of pancreatic head cancer
Jingyong Xu (2017)
10.1007/s00423-015-1320-0
Pancreaticoduodenectomy for distal cholangiocarcinoma: surgical results, prognostic factors, and long-term follow-up
Stefano Andrianello (2015)
10.1007/s11605-015-2882-4
Pancreatectomy with Para-Aortic Lymph Node Dissection for Pancreatic Head Adenocarcinoma: Pattern of Nodal Metastasis Spread and Analysis of Prognostic Factors
Salvatore Paiella (2015)
10.1007/s00423-016-1488-y
Locally advanced pancreatic duct adenocarcinoma: pancreatectomy with planned arterial resection based on axial arterial encasement
Julie Périnel (2016)
10.1186/s12957-016-1005-3
Factors predicting adequate lymph node yield in patients undergoing pancreatoduodenectomy for malignancy
Marek Sierzega (2016)
10.1016/j.hpb.2017.10.017
Does the surgical waiting list affect pathological and survival outcome in resectable pancreatic ductal adenocarcinoma?
Giovanni Marchegiani (2018)
10.1016/j.jamcollsurg.2018.12.031
Pancreatic Cancer Lymph Node Resection Revisited: A Novel Calculation of Number of Lymph Nodes Required.
Amanda Kathleen Arrington (2019)
10.1007/s11605-019-04483-8
Unexpected Para-aortic Lymph Node Metastasis in Pancreatic Ductal Adenocarcinoma: a Contraindication to Resection?
Ji Su Kim (2019)
10.1007/978-3-319-22780-1_16
The Role of the Appleby Operation and Arterial Resection in the Multimodality Management of Borderline Resectable Pancreatic Cancer
Ken-ichi Okada (2016)
10.3389/fonc.2019.01386
Accuracy of Nodal Positivity in Inadequate Lymphadenectomy in Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma: A Population Study Using the US SEER Database
Weishen Wang (2019)
10.1097/SLA.0000000000002668
Proposed Modification of the 8th Edition of the AJCC Staging System for Pancreatic Ductal Adenocarcinoma
Si Shi (2019)
Impacto del drenaje biliar transanastomótico en la morbilidad de la duodenopancreatectomía cefálica
Jesús Santos Naharro (2019)
10.1016/j.cireng.2020.03.013
Is the involvement of the hepatic artery lymph node a poor prognostic factor in pancreatic adenocarcinoma
Victor Rodrigues (2020)
10.1016/j.pan.2019.03.005
Should a standard lymphadenectomy include the No. 9 lymph nodes for body and tail pancreatic ductal adenocarcinoma?
Yiran Zhou (2019)
See more
Semantic Scholar Logo Some data provided by SemanticScholar