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Multicenter Study
. 2024 Jul;31(7):4654-4664.
doi: 10.1245/s10434-024-15213-z. Epub 2024 Apr 11.

Differences in Lymph Node Metastases Patterns Among Non-pancreatic Periampullary Cancers and Histologic Subtypes: An International Multicenter Retrospective Cohort Study and Systematic Review

Bas A Uijterwijk  1   2   3 , Daniël H Lemmers  4   5   6 , Giuseppe Kito Fusai  7 , Alessandro Zerbi  8 , Roberto Salvia  9 , Ernesto Sparrelid  10 , Steven White  11 , Bergthor Björnsson  12 , Vasileios K Mavroeidis  13   14 , Keith J Roberts  15 , Michele Mazzola  16 , Santiago Sánchez Cabús  17 , Zahir Soonawalla  14 , Dimitris Korkolis  18 , Mario Serradilla  19 , Patrick Pessaux  20 , Misha Luyer  21 , Nicholas Mowbray  22 , Benedetto Ielpo  23 , Alessandro Mazzotta  24 , Jorg Kleeff  25 , Ugo Boggi  26 , Miguel Angel Suarez Muñoz  27 , Brian K P Goh  28 , Elena Andreotti  4 , Hanneke Wilmink  29 , Michele Ghidini  30 , Alberto Zaniboni  31 , Caroline Verbeke  32 , Volkan Adsay  33 , Denise Bianchi  34 , Marc G Besselink  5 , Mohammed Abu Hilal  35 ; International Study Group on Non-Pancreatic Periampullary Cancer (ISGACA)
Collaborators, Affiliations
Multicenter Study

Differences in Lymph Node Metastases Patterns Among Non-pancreatic Periampullary Cancers and Histologic Subtypes: An International Multicenter Retrospective Cohort Study and Systematic Review

Bas A Uijterwijk et al. Ann Surg Oncol. 2024 Jul.

Abstract

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.

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Conflict of interest statement

For Misha Luyer, Medtronic and Galvani grants were paid to the institution (Catharina Hospital Eindhoven). Mario Serradilla participated in relevant financial activities for Baxter Healthcare S.L. outside the submitted work. The remaining authors have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Distribution of lymph node metastases among ampullary adenocarcinoma, distal cholangiocarcinoma, and duodenal adenocarcinoma. Lymph node stations: peripancreatic (nos. 13 and 17), infra pyloric (no. 6), common hepatic artery (no. 8), celiac trunk (no. 9), hepatoduodenal ligament (no. 12), superior mesenteric artery (no. 14). Significant differences are found in lymph node stations 6, 12, and 14 (P < 0.05). The percentages correspond with those in Table 2
See this image and copyright information in PMC

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