This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Para‐aortic lymph node sampling in pancreatic head adenocarcinoma. BJS 2014; 101: 530-538.
Published: 13th March 2014
Authors: L. Schwarz, R. M. Lupinacci, M. Svrcek, M. Lesurtel, M. Bubenheim, H. Vuarnesson et al.
Background
The significance of positive para‐aortic nodes in patients with resectable pancreatic carcinoma is unclear. This study sought to evaluate the accuracy of intraoperative detection and prognostic significance of these lymph nodes in patients with resected adenocarcinoma of the pancreatic head.
Method
From 2000 to 2010, para‐aortic node sampling was performed prospectively in all patients before pancreatoduodenectomy. Frozen sections were created and nodes categorized as positive or negative for metastases. Surgeons were blinded to the frozen‐section results. This was followed by standard histopathological assessment of corresponding paraffin‐embedded, haematoxylin and eosin‐stained material. Nodes considered uninvolved by this analysis were examined immunohistochemically for micrometastases.
Results
A total of 111 consecutive patients were included, with a median follow‐up of 20·8 (range 1·5–126) months. The 1‐, 2‐ and 5‐year overall survival (
Conclusion
Para‐aortic node sampling with frozen‐section examination detects distant lymphatic involvement reliably. It should be performed systematically. When metastases are found, they should be considered a contraindication to pancreatic resection.
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Authors: G. Gui, A. Agusti, D. Twelves, S. Tang, M. Kabir, C. Montgomery et al.
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