Relationship between the tumor location and clinicopathological features in left-sided pancreatic ductal adenocarcinoma
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ORIGINAL ARTICLE
Relationship between the tumor location and clinicopathological features in left‑sided pancreatic ductal adenocarcinoma Teijiro Hirashita1 · Yukio Iwashita1 · Atsuro Fujinaga1 · Hiroaki Nakanuma1 · Takashi Masuda1 · Yuichi Endo1 · Masayuki Ohta1 · Masafumi Inomata1 Received: 20 July 2020 / Accepted: 10 September 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose Although the same distal pancreatectomy (DP) is performed regardless of the location of left-sided pancreatic ductal adenocarcinoma (PDAC), the clinicopathological features may differ depending on the tumor location. The present study investigated the relationship between the tumor location and clinicopathological features in patients with left-sided PDAC. Methods The records of 59 patients who underwent DP for PDAC were enrolled. The relationship between the tumor location and clinicopathological features was investigated. The tumor location was classified into three groups according to the 7th AJCC/UICC TNM classification: body (Pb), body and tail (Pbt), and tail (Pt). Results Tumors were located at the Pb in 26 patients, Pbt in 15, and Pt in 18. There was no metastasis to the lymph nodes around the common hepatic artery in Pt. The rate of peritoneal dissemination in the Pt was higher than that in the Pb (P = 0.034) or Pbt (P = 0.002). There were no significant differences in the overall survival among the three groups. Conclusion There was no metastasis to the lymph nodes around the common hepatic artery, and peritoneal dissemination was the most common site of recurrence in Pt tumors. Keywords Pancreas cancer · Left-sided pancreas cancer · Distal pancreatectomy · Prognosis
Introduction Pancreatic ductal adenocarcinoma (PDAC) is a challenging cancer to treat, particularly left-sided PDAC, which is often found at an advanced stage because of a lack of specific symptoms and associated with poor prognosis [1]. Surgical resection is the only curative treatment for PDAC, and distal pancreatectomy (DP) with lymph node (LN) dissection is indicated for left-sided PDAC. Strasberg et al. [2] reported that radical antegrade modular pancreatosplenectomy (RAMPS) is an effective procedure for left-sided PDAC. However, the distance between the tumor and the landmarks for RAMPS, such as the left renal vein or left adrenal gland, varies among individuals. Many factors affecting the outcome following pancreatectomy for PDAC have been reported. The LN status is one of
the most important predictors of survival [3, 4]. Although LN dissection is usually performed, the range of LN dissection is controversial. The International Study Group on Pancreatic Surgery (ISGPS) defined removal of stations 10, 11, and 18 as standard when DP is performed for PDAC [5]. The Japanese Pancreatic Society defines the range as slightly wider, and the precise range is determined not by the tumor location but the operative procedure in the guidelines of both societies [6]. Although the same DP procedure is performed regardless of the location of left-sided PD
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