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What is the optimal surgical approach for ductal adenocarcinoma of the pancreatic neck? - a retrospective cohort study. | LitMetric

AI Article Synopsis

  • - The study investigates the effects of different surgical procedures (pancreatoduodenectomy, distal pancreatectomy, and total pancreatectomy) on outcomes for patients with pancreatic neck tumors, finding similar rates of successful tumor removal (R0-resection) across these methods.
  • - Among 846 patients analyzed, results showed significant differences in lymph node involvement and the number of lymph nodes examined, with total pancreatectomy associated with worse survival rates compared to pancreatoduodenectomy.
  • - The findings suggest that while distal pancreatectomy may lead to inadequate lymph node removal, this did not adversely affect patient survival, indicating that total pancreatectomy does not provide additional survival benefits over partial resections.

Article Abstract

Background: The appropriate surgical approach for pancreatic ductal adenocarcinoma (PDAC) is determined by the tumor's relation to the porto-mesenteric axis. Although the extent and location of lymphadenectomy is dependent on the type of resection, a pancreatoduodenectomy (PD), distal pancreatectomy (DP), or total pancreatectomy (TP) are considered equivalent oncologic operations for pancreatic neck tumors. Therefore, we aimed to assess differences in histopathological and oncological outcomes for surgical approaches in the treatment of pancreatic neck tumors.

Methods: Patients with resected PDAC located in the pancreatic neck were identified from the National Cancer Database (2004-2020). Patients with metastatic disease were excluded. Furthermore, patients with 90-day mortality and R2-resections were excluded from the multivariable Cox-regression analysis.

Results: Among 846 patients, 58% underwent PD, 25% DP, and 17% TP with similar R0-resection rates (p = 0.722). Significant differences were observed in nodal positivity (PD:44%, DP:34%, TP:57%, p < 0.001) and mean-number of examined lymph nodes (PD:17.2 ± 10.4, DP:14.7 ± 10.5, TP:21.2 ± 11.0, p < 0.001). Furthermore, inadequate lymphadenectomy (< 12 nodes) was observed in 30%, 44%, and 19% of patients undergoing PD, DP, and TP, respectively (p < 0.001). Multivariable analysis yielded similar overall survival after DP (HR:0.83, 95%CI:0.63-1.11), while TP was associated with worse survival (HR:1.43, 95%CI:1.08-1.89) compared to PD.

Conclusion: While R0-rates are similar amongst all approaches, DP is associated with inadequate lymphadenectomy which may result in understaging disease. However, this had no negative influence on survival. In the premise that an oncological resection of the pancreatic neck tumor is feasible with a partial pancreatectomy, no benefit is observed by performing a TP.

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Source
http://dx.doi.org/10.1007/s00423-024-03417-6DOI Listing

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