Ubels, S. (2018) Pancreaticoduodenectomy for pancreatic head malignancies with para-aortic lymph node metastasis: Possible survival benefit at the cost of complications and morbidity. A two-part retrospective cohort study. thesis, Medicine.
Full text available on request.Abstract
Introduction Pancreatic ductal adenocarcinoma and distal cholangiocarcinoma are tumours with poor prognosis. Patients with para-aortic lymph nodes (PALN) metastasis have even dismal prognosis. Although PALN dissection is not included in standard lymphadenectomy guidelines, it is routinely performed in many centres. Some expert centres abandon a resection with curative intent in case of PALN metastasis found during intraoperative sampling, whereas others do not implicate PALN status in their surgical treatment decisions. The aim of this study is to assess the association of PALN metastasis and survival and assess the impact of the treatment strategy: pancreaticoduodenectomy (PD) versus palliative double bypass (DBP). Methods Part I: Single centre retrospective cohort study in N1 patients who underwent PD with PALN sampling. Primary endpoint was overall survival between PALN+ and PALN- patients. Part II: Multicentre retrospective cohort study of PALN+ patients treated with PD or DBP. Primary endpoint was survival of PD and DBP patients, secondary endpoints were complications and morbidity. Results Part I: 48 N1 patients were included. PALN metastases were found in 19.4% of patients. Median overall survival of PALN+ patients compared to PALN- patients was 10.6 months vs. 18.6 months (p=0.009). PALN metastasis was an independent predictor of survival, HR 3.109 (p=0.004). Part II: 60 PALN+ patients were included, 32 received PD, 28 received DBP. Median overall survival of PD patients was 12.0 months vs. 7.9 months for DBP (p=0.179). PD was not an independent predictor of survival. PD patients had significantly more severe complications and higher morbidity-score. Conclusion PALN metastases were significantly associated with 8 months shorter overall survival versus PALN negative patients. Given the high metastatic incidence and significant impact on prognosis, PALN is advised as part of the standard lymphadenectomy. In PALN+ patients PD may give a very limited survival benefit at the cost of significantly more perioperative morbidity. Therefore, in patients with PALN metastases survival and perioperative risk stratification tools are important to include in decisions regarding treatment strategy.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervised by and Patijn, G.A.MD PhD and Statistical supervision by and Brohet, R.M. PhD and Depart ment of surgery, Isala and The Netherlands |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:40 |
| Last Modified: | 25 Jun 2020 10:40 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/205 |
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