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Para-aortic lymph node metastasis detected intraoperatively by systematic frozen section examination in pancreatic head adenocarcinoma: is resection improving the prognosis?
HPB ( IF 2.9 ) Pub Date : 2020-03-27 , DOI: 10.1016/j.hpb.2020.02.009
Maxime Collard 1 , Thibault Voron 1 , Magali Svrcek 2 , Omar Ahmed 1 , Pierre Balladur 3 , Thévy Hor 1 , Thierry André 4 , François Paye 3
Affiliation  

Background

This study aimed to evaluate the controversial benefit of a pancreaticoduodenectomy (PD) in patients with PALN metastasis intraoperatively detected by systematic frozen section examination in pancreatic adenocarcinoma.

Methods

PALN intraoperative examination by frozen section was systematically performed from January 2006 to February 2018 prior to performing PD for pancreatic adenocarcinoma. Until June 2012, PALN + patients still underwent PD (PALN+/PD group) in the framework of a prospective study. Since July 2012, PALN+ was considered as contraindicating the planned PD (PALN+/No-PD group). Post-operative morbidity and survival were compared between these two groups.

Results

Of the 32 PALN + patients intraoperatively detected, the first 13 underwent a PD, while the last 19 did not undergo resection. Seven patients (54%) among 13 PALN+/PD patients developed a post-operative complication against 3 (16%) among 19 PALN+/No-PD patients (p = 0.049). The median length of stay was 5 days longer for PALN+/PD patients (p = 0.001). The median survival did not differ between PALN+/No-PD and PALN+/PD groups (respectively 13.4 months (95%CI:7.6–19.3) and 11.5 months (95%CI:5.9–17.1), p = 0.471). No patient was alive 4 years after surgery in both the PALN+/No-PD or PALN+/PD groups.

Conclusion

In case of PALN detected intraoperatively in pancreatic adenocarcinoma, PD does not improve survival compared to current palliative treatment.



中文翻译:

术中系统冰冻切片检查发现胰头腺癌主动脉旁淋巴结转移:切除是否改善预后?

背景

本研究旨在评估胰十二指肠切除术 (PD) 对术中通过系统冰冻切片检查发现的胰腺腺癌 PALN 转移患者的有争议的益处。

方法

2006 年 1 月至 2018 年 2 月,在对胰腺癌进行 PD 之前,系统地进行了 PALN 术中冰冻切片检查。直到 2012 年 6 月,PALN+ 患者仍在前瞻性研究框架内接受 PD(PALN+/PD 组)。自 2012 年 7 月起,PALN+ 被视为计划 PD 的禁忌症(PALN+/No-PD 组)。比较这两组的术后发病率和生存率。

结果

在术中检测到的 32 名 PALN + 患者中,前 13 名接受了 PD,而后 19 名未接受切除术。13 名 PALN+/PD 患者中有 7 名 (54%) 出现术后并发症,而 19 名 PALN+/无 PD 患者中有 3 名 (16%) (p = 0.049)。PALN+/PD 患者的中位住院时间长 5 天(p = 0.001)。PALN+/No-PD 和 PALN+/PD 组的中位生存期没有差异(分别为 13.4 个月(95%CI:7.6-19.3)和 11.5 个月(95%CI:5.9-17.1),p = 0.471)。在 PALN+/No-PD 或 PALN+/PD 组中,手术后 4 年没有患者存活。

结论

在胰腺癌术中检测到 PALN 的情况下,与目前的姑息治疗相比,PD 不会提高生存率。

更新日期:2020-03-27
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