Detailed Abstract
[BP Oral Presentation 1 - Biliary & Pancreas (Pancreas Disease/Surgery)]
[BP OP 1-5] LYMPH NODE METASTATIC PATTERNS AND APPROPRIATE EXTENT OF DISSECTION IN LEFT-SIDED PANCREATIC CANCER
Inhyuck LEE 1, Younsoo SEO 1, Go-Won CHOI 1, Yoon Soo CHAE 1, Won-Gun YUN 1, Youngmin HAN 1, Hye-Sol JUNG 1, Young Jae CHO 1, Joon Seong PARK 1, Jin-Young JANG 1, Wooil KWON 1
1 Surgery, Seoul National University Hospital, Korea
Background : Pancreatic cancer is one of the deadliest malignancies, with a 5-year survival rate of only 15%. Lymph node (LN) metastasis is a critical prognostic factor, observed in over 60% of patients undergoing curative surgery. Although standardized lymph node dissection (LND) is recommended, the role of extrapancreatic lymph node dissection (ELND) remains unclear, especially in left-sided pancreatic cancer.
Methods : This single-center retrospective study analyzed 528 patients who underwent distal pancreatectomy for non-metastatic pancreatic ductal adenocarcinoma. ELND, defined as dissection of at least one extrapancreatic LN station (#7, #8, #9, or #14), was performed in 55% of cases. Propensity score matching (PSM) balanced key variables, enabling comparison of ELND outcomes in pancreatic body and tail cancers.
Results : After PSM, ELND provided no significant survival benefit in pancreatic tail cancer, with 5-year OS rates of 43.5% (ELND) vs. 45.0% (non-ELND, p = 0.947). In contrast, pancreatic body cancer demonstrated improved OS with ELND (5-year OS: 57.0% vs. 38.5%, p = 0.003), although recurrence-free survival (RFS) differences were not significant.
Conclusions : The efficacy of ELND in left-sided pancreatic cancer is location-dependent. ELND improves OS in pancreatic body cancer but offers no survival advantage in pancreatic tail cancer. Tailored surgical strategies are essential, with a conservative approach warranted for pancreatic tail cancer to minimize morbidity, while more extensive dissection may benefit body cancer patients. Prospective studies are needed to confirm these findings.
Methods : This single-center retrospective study analyzed 528 patients who underwent distal pancreatectomy for non-metastatic pancreatic ductal adenocarcinoma. ELND, defined as dissection of at least one extrapancreatic LN station (#7, #8, #9, or #14), was performed in 55% of cases. Propensity score matching (PSM) balanced key variables, enabling comparison of ELND outcomes in pancreatic body and tail cancers.
Results : After PSM, ELND provided no significant survival benefit in pancreatic tail cancer, with 5-year OS rates of 43.5% (ELND) vs. 45.0% (non-ELND, p = 0.947). In contrast, pancreatic body cancer demonstrated improved OS with ELND (5-year OS: 57.0% vs. 38.5%, p = 0.003), although recurrence-free survival (RFS) differences were not significant.
Conclusions : The efficacy of ELND in left-sided pancreatic cancer is location-dependent. ELND improves OS in pancreatic body cancer but offers no survival advantage in pancreatic tail cancer. Tailored surgical strategies are essential, with a conservative approach warranted for pancreatic tail cancer to minimize morbidity, while more extensive dissection may benefit body cancer patients. Prospective studies are needed to confirm these findings.
SESSION
BP Oral Presentation 1
Room 2 3/27/2025 3:30 PM - 4:30 PM