The clinical significance of standardized regional lymph node dissection in pancreatic head cancer pancreatoduodenectomy

Objective To explore and discuss the clinical significance of standardized regional lymph node dissection in pancreatic head cancer pancreatoduodenectomy.Methods Forty-eight cases of pancreatic head cancer with standardized regional lymph node dissection based on the conventional whipple from January 2008 to October 2010 in our department were retrospectively analyzed.The standardized regional lymph node dissection was performed using the JPS lymph node group standard(5th edition,2002),which includes all lymph nodes around the hepatic artery(8a,8p),the celiac trunk(9) and the hepatoduodenal ligament(12habpc),all lymph nodes behind pancreas and duodenum(13a,13b),lymph nodes near the right side of SMA from the start part of SMA to inferior pancreaticoduodenal artery(IPDA)(14abcd),lymph nodes in front of pancreas(17a,17b),lymph nodes in front of the abdominal aorta and inferior vena cava from celiac artery to superior mesenteric artery(IMA) as well as the Gerota fascia.Results The entire 48 patients received whipple D2 radical surgery included standardized regional lymph node dissection,and all of the cases were performed the pancreatic and biliary-section examination that confirmed no positive during the surgery.One of the patients received the partial resection and reconstruction of the superior mesenteric vein because of the tumor invading.After the surgery,2 cases complicated with a small amount of pancreatic fistula,2 cases of gastric paralysis,3 cases of wound infection,1 case of acute left ventricular failure,and 1 died from multiple organ failure.The pathological report showed there were lymph node metastasis in 20 cases(41.6%) among 48 patients,in which,back of pancreas and duodenum(13a,13b),lymph nodes around the start part of SMA(14abcd) were the highest incidence places(8/48,16.7%).Of all the cases,N1 lymph nodes metastasis were found in 4 people(8/20,40.0%),N2 lymph nodes metastasis in 3 people(6/20,30.0%),N3 lymph nodes metastasis in 3 people(6/20,30.0%).Conclusion Standardized regional lymph node dissection can effectively rid up more lymph nodes and retroperitoneum tissue,without increasing its mortality and complications of the surgery.