Prognostic significance of dissecting the nerve plexus around the common hepatic artery in pancreatic cancer
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ORIGINAL ARTICLE
Prognostic significance of dissecting the nerve plexus around the common hepatic artery in pancreatic cancer Kenjiro Okada 1 & Kenichiro Uemura 1 & Naru Kondo 1 & Tatsuaki Sumiyoshi 1 & Naoya Nakagawa 1 & Shingo Seo 1 & Hiroyuki Otsuka 1 & Kazuhide Urabe 1 & Yoshiaki Murakami 1 & Shinya Takahashi 1 Received: 14 July 2020 / Accepted: 3 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose This study aims to investigate the positivity rate of the nerve plexus (NPL) around the common hepatic artery (CHA), as well as the impact of dissecting the NPL-CHA, during surgical resection of pancreatic cancer. Methods Clinicopathological factors, including hematoxylin and eosin (H&E) staining and immunohistochemistry, were compared between the resectable pancreatic cancer (RPC) and borderline resectable PC (BRPC) groups. Moreover, the relationship between the NPL-CHA status and overall survival (OS) was investigated. Results In this study, 136 eligible patients were divided into the RPC (72) and BRPC (64) groups. In the RPC group, all patients were negative for H&E staining and microinvasion, whereas 13 (20%) and five patients (8%) were positive for H&E staining and microinvasion, respectively, in the BRPC group. The median OS times in the NPL-CHA–positive and –negative groups were 29.8 and 60.2 months, respectively (p = 0.088). The multivariate analysis of OS indicated an elevated initial carbohydrate antigen 19-9, lymph node (LN) metastasis, and lack of adjuvant chemotherapy (AC), which independently predicted poor outcomes. In the BRPC subgroup, contact with the CHA on preoperative computed tomography (CT) was a high-risk factor for NPL-CHA positivity. Conclusion NPL-CHA positivity was only present in the BRPC group. In the absence of CT evidence of CHA contact, NPLCHA dissection may not have survival benefits. Keywords Pancreatic cancer . Nerve plexus . Common hepatic artery . Pancreatectomy . Resectability status
Abbreviations NPL Nerve plexus NCCN National Comprehensive Cancer Network CHA Common hepatic artery RPC Resectable pancreatic cancer BRPC Borderline resectable pancreatic cancer PD Pancreatoduodenectomy NAT Neoadjuvant therapy DP-CAR Distal pancreatectomy with celiac axis resection AC Adjuvant chemotherapy H&E Hematoxylin and eosin LN Lymph node
* Kenjiro Okada [email protected] 1
Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima 734-8551, Japan
CT OS RFS HR CI IQR LN8 CA19-9
Computed tomography Overall survival Recurrence-free survival Hazard ratio Confidence interval Interquartile range Lymph node around the common hepatic artery Carbohydrate antigen 19-9
Introduction Pancreatic cancer is one of the most aggressive and lethal malignancies, ranking as the fourth leading cause of cancerrelated death, and its prevalence has also been steadily increasing [1]. A major issue is that 50–60% of patients are diagnosed with advanced disease at presentation, and surgery is
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