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Role of lymphadenectomy in resectable pancreatic cancer

  • Review Article
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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.

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Authors and Affiliations

  1. Moores Cancer Center, University of California San Diego, San Diego, CA, USA

    Suna Erdem & Rebekah White

  2. Department of Visceral Surgery, Clarunis, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland

    Martin Bolli, Markus von Flüe & Mathias Worni

  3. Swiss Institute for Translational and Entrepreneurial Medicine, Stiftung Lindenhof, Campus SLB, Bern, Switzerland

    Sascha A. Müller & Mathias Worni

  4. Department of Surgery, Clinic Beau Site, Bern, Switzerland

    Sascha A. Müller & Mathias Worni

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  1. Suna Erdem
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Erdem, S., Bolli, M., Müller, S.A. et al. Role of lymphadenectomy in resectable pancreatic cancer. Langenbecks Arch Surg 405, 889–902 (2020). https://doi.org/10.1007/s00423-020-01980-2

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