Role of lymphadenectomy in resectable pancreatic cancer
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REVIEW ARTICLE
Role of lymphadenectomy in resectable pancreatic cancer Suna Erdem 1 & Martin Bolli 2 & Sascha A. Müller 3,4 & Markus von Flüe 2 & Rebekah White 1 & Mathias Worni 2,3,4 Received: 27 August 2020 / Accepted: 31 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Pancreatic cancer (PC) remains one of the most devastating malignant diseases, predicted to become the second leading cause of cancer-related death by 2030. Despite advances in surgical techniques and in systemic therapy, the 5-year relative survival remains a grim 9% for all stages combined. The extent of lymphadenectomy has been discussed intensively for decades, given that even in early stages of PC, lymph node (LN) metastasis can be detected in approximately 80%. Purpose The primary objective of this review was to provide an overview of the current literature evaluating the role of lymphadenectomy in resected PC. For this, we evaluated randomized controlled studies (RCTs) assessing the impact of extent of lymphadenectomy on OS and studies evaluating the prognostic impact of anatomical site of LN metastasis and the impact of the number of resected LNs on OS. Conclusions Lymphadenectomy plays an essential part in the multimodal treatment algorithm of PC and is an additional therapeutic tool to increase the chance for surgical radicality and to ensure correct staging for optimal oncological therapy. Based on the literature from the last decades, standard lymphadenectomy with resection of at least ≥ 15 LNs is associated with an acceptable postoperative complication risk and should be recommended to obtain local radicality and accurate staging of the disease. Although radical surgery including appropriate lymphadenectomy of regional LNs remains the only chance for long-term tumor control, future studies specifically assessing the impact of neoadjuvant therapy on extraregional LNs are warranted. Keywords Pancreatic cancer . Lymph node . Lymphadenectomy . Survival
Introduction Pancreatic cancer (PC) is the most aggressive gastrointestinal cancer and currently the fourth leading cause of cancer-related death worldwide [1]. PC is expected to be the second leading cause of cancer-related death by 2030 in Western countries with a 5-year relative survival rate of 9% for all stages combined [1]. Surgical resection followed by adjuvant chemotherapy offers the only chance for cure. However, only up to 20% * Mathias Worni [email protected] 1
Moores Cancer Center, University of California San Diego, San Diego, CA, USA
2
Department of Visceral Surgery, Clarunis, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
3
Swiss Institute for Translational and Entrepreneurial Medicine, Stiftung Lindenhof, Campus SLB, Bern, Switzerland
4
Department of Surgery, Clinic Beau Site, Bern, Switzerland
of affected patients initially present with potentially resectable disease [2]. For the remaining patients, surgery cannot be offered upfront, giv
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