Differences in Lymph Node Metastases Patterns Among Non-pancreatic Periampullary Cancers and Histologic Subtypes: An International Multicenter Retrospective Cohort Study and Systematic Review
Por:
Uijterwijk, BA, Lemmers, DH, Fusai, GK, Zerbi, A, Salvia, R, Sparrelid, E, White, S, Björnsson, B, Mavroeidis, VK, Roberts, KJ, Mazzola, M, Cabus, SS, Soonawalla, Z, Korkolis, D, Serradilla, M, Pessaux, P, Luyer, M, Mowbray, N, Ielpo, B, Mazzotta, A, Kleeff, J, Boggi, U, Munoz, MAS, Goh, BKP, Andreotti, E, Wilmink, H, Ghidini, M, Zaniboni, A, Verbeke, C, Adsay, V, Bianchi, D, Besselink, MG, Abu Hilal, M, Nappo, G, Ghorbani, P, Malleo, G, Lancelotti, F, Napoli, N, Robinson, S, Khalil, K, Val, ARD, Mortimer, MCM, Al-Sarireh, B, Koh, YX, Bhogal, R, Serrablo, A, Gayet, B, Johansen, K, Ramaekers, M, Giani, A
Publicada:
11 abr 2024
Ahead of Print:
1 abr 2024
Resumen:
Background: Standard lymphadenectomy for pancreatoduodenectomy is defined for pancreatic ductal adenocarcinoma and adopted for patients with non-pancreatic periampullary cancer (NPPC), ampullary adenocarcinoma (AAC), distal cholangiocarcinoma (dCCA), or duodenal adenocarcinoma (DAC). This study aimed to compare the patterns of lymph node metastases among the different NPPCs in a large series and in a systematic review to guide the discussion on surgical lymphadenectomy and pathology assessment. Methods: This retrospective cohort study included patients after pancreatoduodenectomy for NPPC with at least one lymph node metastasis (2010-2021) from 24 centers in nine countries. The primary outcome was identification of lymph node stations affected in case of a lymph node metastasis per NPPC. A separate systematic review included studies on lymph node metastases patterns of AAC, dCCA, and DAC. Results: The study included 2367 patients, of whom 1535 had AAC, 616 had dCCA, and 216 had DAC. More patients with pancreatobiliary type AAC had one or more lymph node metastasis (67.2% vs 44.8%; P < 0.001) compared with intestinal-type, but no differences in metastasis pattern were observed. Stations 13 and 17 were most frequently involved (95%, 94%, and 90%). Whereas dCCA metastasized more frequently to station 12 (13.0% vs 6.4% and 7.0%, P = 0.005), DAC metastasized more frequently to stations 6 (5.0% vs 0% and 2.7%; P < 0.001) and 14 (17.0% vs 8.4% and 11.7%, P = 0.015). Conclusion: This study is the first to comprehensively demonstrate the differences and similarities in lymph node metastases spread among NPPCs, to identify the existing research gaps, and to underscore the importance of standardized lymphadenectomy and pathologic assessment for AAC, dCCA, and DAC.
Filiaciones:
Uijterwijk, BA:
Fdn Poliambulanza, Dept Surg, Brescia, Italy
Locat Univ Amsterdam, Dept Surg, Amsterdam UMC, Amsterdam, Netherlands
Canc Ctr Amsterdam, Amsterdam, Netherlands
Lemmers, DH:
Fdn Poliambulanza, Dept Surg, Brescia, Italy
Locat Univ Amsterdam, Dept Surg, Amsterdam UMC, Amsterdam, Netherlands
Canc Ctr Amsterdam, Amsterdam, Netherlands
Fusai, GK:
Royal Free London NHS Fdn Trust, Dept Surg, London, England
Zerbi, A:
Humanitas Univ, IRCCS Humanitas Res Hosp, Dept Biomed Sci, Italy & Pancreat Surg, Rozzano, Italy
Salvia, R:
Univ Verona Hosp Trust, Pancreas Inst, Dept Gen & Pancreat Surg, Verona, Italy
Sparrelid, E:
Karolinska Inst, Karolinska Univ Hosp, Dept Clin Sci Intervent & Technol, Div Surg, Stockholm, Sweden
White, S:
Newcastle Tyne Hosp NHS Fdn Trust, Dept Surg, Newcastle Upon Tyne, Tyne & Wear, England
Björnsson, B:
Linkoping Univ, Dept Surg Linkoping, Linkoping, Sweden
Linkoping Univ, Dept Biomed & Clin Sci, Linkoping, Sweden
Mavroeidis, VK:
Royal Marsden Hosp, Dept Acad Surg, London, England
Oxford Univ Hosp NHS Fdn Trust, Dept Hepatobiliary & Pancreat Surg, Oxford, England
Roberts, KJ:
Univ Birmingham, Fac Med, Birmingham, W Midlands, England
Mazzola, M:
ASST Grande Osped Metropolitano Niguarda, Div Oncol & Mini Invas Gen Surg, Milan, Italy
Cabus, SS:
Hosp Santa Creu & Sant Pau, Dept Surg, Barcelona, Spain
Soonawalla, Z:
Oxford Univ Hosp NHS Fdn Trust, Dept Hepatobiliary & Pancreat Surg, Oxford, England
Korkolis, D:
Hellen Anticanc Hosp St Savvas, Dept Surg, Athens, Greece
Serradilla, M:
Miguel Servet Univ Hosp, Dept Surg, Zaragoza, Spain
Pessaux, P:
Nouvel Hop Civil NHC, Hepatobiliary & Pancreat Surg Unit, Strasbourg, France
Luyer, M:
Catharina Hosp, Dept Surg, Eindhoven, Netherlands
Mowbray, N:
Morriston Hosp, Dept Surg, Swansea, W Glam, Wales
Ielpo, B:
Hosp Mar, Dept Surg, Barcelona, Spain
Mazzotta, A:
Inst Mutualiste Montsouris, Dept Digest Oncol & Metab Surg, Paris, France
Kleeff, J:
Martin Luther Univ Halle Wittenberg, Dept Surg, Halle, Saale, Germany
Boggi, U:
Pisa Univ Hosp, Dept Surg, Pisa, Italy
Munoz, MAS:
Univ Hosp Virgen Victoria, Dept Surg, Malaga, Spain
Goh, BKP:
Duke Natl Univ Singapore, Singapore Gen Hosp, Dept Hepatopancreatobiliary & Transplant Surg, Singapore, Singapore
Andreotti, E:
Fdn Poliambulanza, Dept Surg, Brescia, Italy
Wilmink, H:
Univ Amsterdam, Dept Med Oncol, Amsterdam UMC, Amsterdam, Netherlands
Ghidini, M:
Fdn IRCCS Ca Granda Osped Maggiore Policlin, Oncol Unit, Milan, Italy
Zaniboni, A:
Fdn Poliambulanza, Dept Med Oncol, Brescia, Italy
Verbeke, C:
Univ Oslo, Oslo Univ Hosp, Dept Pathol, Oslo, Norway
Adsay, V:
Koc Univ Hosp, Dept Pathol, Istanbul, Turkiye
Koc Univ, Res Ctr Translat Med KUTTAM, Istanbul, Turkiye
Bianchi, D:
Fdn Poliambulanza, Dept Pathol, Brescia, Italy
Besselink, MG:
Locat Univ Amsterdam, Dept Surg, Amsterdam UMC, Amsterdam, Netherlands
Abu Hilal, M:
Fdn Poliambulanza, Dept Surg, Brescia, Italy
Malleo, G:
Fdn Poliambulanza, Dept Surg, Brescia, Italy
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