Skip to main content

Advertisement

SpringerLink
Log in

Postoperative prognosis of pancreatic cancer with para-aortic lymph node metastasis: a multicenter study on 822 patients

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

The prognosis of pancreatic cancer patients with metastatic para-aortic lymph node (PALN) has been reported to be extremely poor. In general, PALN metastasis has been considered as a contraindication for pancreatic resection. The aim of this study was to reevaluate the postoperative prognostic value of PALN metastasis in pancreatic cancer and to determine the validity of pancreatic surgery.

Methods

Retrospective multicenter analysis of 882 patients who have undergone curative-intent pancreatic resection with pathological evaluation of PALNs for pancreatic ductal adenocarcinoma between 2001 and 2012 was conducted. Clinicopathological data and outcomes were evaluated with univariate and multivariate analysis.

Results

In total, 102 (12.4 %) patients had positive metastasis in PALN. Patients with metastatic PALN had significantly poorer survival than those without (17 vs. 23 months; p < 0.001). Multivariable analysis of 822 patients identified adjuvant chemotherapy, primary tumor status, regional lymph node metastasis, portal vein invasion, pre- and post-operative serum CA19-9 levels, and tumor grade as independent prognostic factors. In contrast, PALN metastasis did not have a significant prognostic value. Furthermore, the multivariate prognostic analysis in patients with PALN metastasis revealed that adjuvant chemotherapy and the number of metastatic PALN were significantly associated with long-term survival. Lung metastasis as initial recurrence was observed more often in patients with PALN metastasis in comparison with those without.

Conclusions

Some pancreatic cancer patients with metastatic PALN may survive for longer than expected after pancreatectomy. Adjuvant chemotherapy and the number of metastatic PALN were critical factors for long-term survival of those patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ma J, Siegel R, Jemal A. Pancreatic cancer death rates by race among US men and women, 1970–2009. J Natl Cancer Inst. 2013;105:1694–700.

    Article  PubMed  Google Scholar 

  2. Egawa S, Toma H, Ohigashi H, Okusaka T, Nakao A, Hatori T, et al. Japan Pancreatic Cancer Registry; 30th year anniversary: Japan Pancreas Society. Pancreas. 2012;41:985–92.

    Article  PubMed  Google Scholar 

  3. Ueno H, Ioka T, Ikeda M, Ohkawa S, Yanagimoto H, Boku N, et al. Randomized phase III study of gemcitabine plus S-1, S-1 alone, or gemcitabine alone in patients with locally advanced and metastatic pancreatic cancer in Japan and Taiwan: GEST study. J Clin Oncol. 2013;31:1640–8.

    Article  CAS  PubMed  Google Scholar 

  4. Moore MJ, Goldstein D, Hamm J, Figer A, Hecht JR, Gallinger S, et al. Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol. 2007;25:1960–6.

    Article  CAS  PubMed  Google Scholar 

  5. Paulson AS, Tran Cao HS, Tempero MA, Lowy AM. Therapeutic advances in pancreatic cancer. Gastroenterology. 2013;144:1316–26.

    Article  CAS  PubMed  Google Scholar 

  6. Konstantinidis IT, Warshaw AL, Allen JN, Blaszkowsky LS, Castillo CF, Deshpande V, et al. Pancreatic ductal adenocarcinoma: is there a survival difference for R1 resections versus locally advanced unresectable tumors? What is a “true” R0 resection? Ann Surg. 2013;257:731–6.

    Article  PubMed  Google Scholar 

  7. Schnelldorfer T, Ware AL, Sarr MG, Smyrk TC, Zhang L, Qin R, et al. Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible? Ann Surg. 2008;247:456–62.

    Article  PubMed  Google Scholar 

  8. Tamm EP, Balachandran A, Bhosale PR, Katz MH, Fleming JB, Lee JH, et al. Imaging of pancreatic adenocarcinoma: update on staging/resectability. Radiol Clin North Am. 2012;50:407–28.

    Article  PubMed  Google Scholar 

  9. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–4.

    Article  PubMed  Google Scholar 

  10. Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumors. 7th ed. New York: Wiley; 2010.

  11. Shimada K, Sakamoto Y, Sano T, Kosuge T. The role of paraaortic lymph node involvement on early recurrence and survival after macroscopic curative resection with extended lymphadenectomy for pancreatic carcinoma. J Am Coll Surg. 2006;203:345–52.

    Article  PubMed  Google Scholar 

  12. Murakami Y, Uemura K, Sudo T, Hashimoto Y, Yuasa Y, Sueda T. Prognostic impact of para-aortic lymph node metastasis in pancreatic ductal adenocarcinoma. World J Surg. 2010;34:1900–7.

    Article  PubMed  Google Scholar 

  13. Doi R, Kami K, Ito D, Fujimoto K, Kawaguchi Y, Wada M, et al. Prognostic implication of para-aortic lymph node metastasis in resectable pancreatic cancer. World J Surg. 2007;31:147–54.

    Article  PubMed  Google Scholar 

  14. Kanda M, Fujii T, Nagai S, Kodera Y, Kanzaki A, Sahin TT, et al. Pattern of lymph node metastasis spread in pancreatic cancer. Pancreas. 2011;40:951–5.

    Article  PubMed  Google Scholar 

  15. Sakai M, Nakao A, Kaneko T, Takeda S, Inoue S, Kodera Y, et al. Para-aortic lymph node metastasis in carcinoma of the head of the pancreas. Surgery. 2005;137:606–11.

    Article  PubMed  Google Scholar 

  16. Schwarz L, Lupinacci RM, Svrcek M, Lesurtel M, Bubenheim M, Vuarnesson H, et al. Para-aortic lymph node sampling in pancreatic head adenocarcinoma. Br J Surg. 2014;101:530–8.

    Article  CAS  PubMed  Google Scholar 

  17. Satoi S, Yamaue H, Kato K, Takahashi S, Hirono S, Takeda S, et al. Role of adjuvant surgery for patients with initially unresectable pancreatic cancer with a long-term favorable response to non-surgical anti-cancer treatments: results of a project study for pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci. 2013;20(6):590–600.

    Article  PubMed  Google Scholar 

  18. Aristu J, Canon R, Pardo F, Martinez-Monge R, Martin-Algarra S, Manuel Ordonez J, et al. Surgical resection after preoperative chemoradiotherapy benefits selected patients with unresectable pancreatic cancer. Am J Clin Oncol. 2003;26:30–6.

    Article  PubMed  Google Scholar 

  19. Bickenbach KA, Gonen M, Tang LH, O’Reilly E, Goodman K, Brennan MF, et al. Downstaging in pancreatic cancer: a matched analysis of patients resected following systemic treatment of initially locally unresectable disease. Ann Surg Oncol. 2012;19:1663–9.

    Article  CAS  PubMed  Google Scholar 

  20. Masui T, Kubota T, Aoki K, Nakanishi Y, Miyamoto T, Nagata J, et al. Long-term survival after resection of pancreatic ductal adenocarcinoma with para-aortic lymph node metastasis: case report. World J Surg Oncol. 2013;11:195.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Japan Pancreas Society. Classification of pancreatic carcinoma (2nd English edition). Japan Pancreas Society e: Kanehara & Co.; 2003.

    Google Scholar 

  22. Conroy T, Desseigne F, Ychou M, Bouche O, Guimbaud R, Becouarn Y, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364:1817–25.

    Article  CAS  PubMed  Google Scholar 

  23. Von Hoff DD, Ervin T, Arena FP, Chiorean EG, Infante J, Moore M, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013;369:1691–703.

    Article  Google Scholar 

  24. Oettle H, Post S, Neuhaus P, Gellert K, Langrehr J, Ridwelski K, et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA. 2007;297:267–77.

    Article  CAS  PubMed  Google Scholar 

  25. Ueno H, Kosuge T, Matsuyama Y, Yamamoto J, Nakao A, Egawa S, et al. A randomised phase III trial comparing gemcitabine with surgery-only in patients with resected pancreatic cancer: Japanese Study Group of Adjuvant Therapy for Pancreatic Cancer. Br J Cancer. 2009;101:908–15.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Sho M, Tanaka T, Yamada T, Nomi T, Akahori T, Doh J, et al. Novel postoperative adjuvant strategy prevents early hepatic recurrence after resection of pancreatic cancer. J Hepatobiliary Pancreat Sci. 2011;18:235–9 (discussion 9–40).

    Article  PubMed  Google Scholar 

  27. Murakami Y, Uemura K, Sudo T, Hashimoto Y, Nakashima A, Kondo N, et al. Long-term results of adjuvant gemcitabine plus S-1 chemotherapy after surgical resection for pancreatic carcinoma. J Surg Oncol. 2012;106:174–80.

    Article  CAS  PubMed  Google Scholar 

  28. Imai H, Doi R, Kanazawa H, Kamo N, Koizumi M, Masui T, et al. Preoperative assessment of para-aortic lymph node metastasis in patients with pancreatic cancer. Int J Clin Oncol. 2010;15:294–300.

    Article  PubMed  Google Scholar 

  29. Matsumoto I, Shirakawa S, Shinzeki M, Asari S, Goto T, Ajiki T, et al. 18-Fluorodeoxyglucose positron emission tomography does not aid in diagnosis of pancreatic ductal adenocarcinoma. Clin Gastroenterol Hepatol. 2013;11:712–8.

    Article  PubMed  Google Scholar 

  30. Yamada S, Nakao A, Fujii T, Sugimoto H, Kanazumi N, Nomoto S, et al. Pancreatic cancer with paraaortic lymph node metastasis: a contraindication for radical surgery? Pancreas. 2009;38:e13–7.

    Article  PubMed  Google Scholar 

  31. Nagai H, Kuroda A, Morioka Y. Lymphatic and local spread of T1 and T2 pancreatic cancer. A study of autopsy material. Ann Surg. 1986;204:65–71.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Hirono S, Tani M, Kawai M, Okada K, Miyazawa M, Shimizu A, et al. Identification of the lymphatic drainage pathways from the pancreatic head guided by indocyanine green fluorescence imaging during pancreaticoduodenectomy. Dig Surg. 2012;29:132–9.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan

    Masayuki Sho, Takahiro Akahori, Shoichi Kinoshita, Minako Nagai, Satoshi Nishiwada & Yoshiyuki Nakajima

  2. Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan

    Yoshiaki Murakami & Kenichiro Uemura

  3. Division of Gastroenterological Surgery, Department of Surgery, Tohoku University, Sendai, Japan

    Fuyuhiko Motoi & Michiaki Unno

  4. Department of Surgery, Kansai Medical University, Osaka, Japan

    Sohei Satoi & Hiroaki Yanagimoto

  5. Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan

    Ippei Matsumoto & Takumi Fukumoto

  6. Second Department of Surgery, Wakayama Medical University, Wakayama, Japan

    Manabu Kawai & Hiroki Yamaue

  7. Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan

    Goro Honda & Masanao Kurata

Authors
  1. Masayuki Sho
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshiaki Murakami
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fuyuhiko Motoi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sohei Satoi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ippei Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Manabu Kawai
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Goro Honda
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kenichiro Uemura
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hiroaki Yanagimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Masanao Kurata
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Takumi Fukumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Takahiro Akahori
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Shoichi Kinoshita
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Minako Nagai
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Satoshi Nishiwada
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Michiaki Unno
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Hiroki Yamaue
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Yoshiyuki Nakajima
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masayuki Sho.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sho, M., Murakami, Y., Motoi, F. et al. Postoperative prognosis of pancreatic cancer with para-aortic lymph node metastasis: a multicenter study on 822 patients. J Gastroenterol 50, 694–702 (2015). https://doi.org/10.1007/s00535-014-1005-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00535-014-1005-4

Keywords

Search

Navigation