Adequacy of Lymph Node Retrieval for Ampullary Cancer and Its Association with Improved Staging and Survival

作者：Partelli Stefano^*; Crippa Stefano; Capelli Paola; Neri Anna; Bassi Claudio; Zamboni Giuseppe; Barugola Giuliano; Falconi Massimo

来源：World Journal of Surgery, 2013, 37(6): 1397-1404.

DOI：10.1007/s00268-013-1995-8

The aim of the present study was to determine the optimal number of lymph nodes (LN) examined to stage pN0 tumors after surgery for ampulla of Vater carcinoma (AVC). %26lt;br%26gt;We reviewed retrospectively 127 patients with AVC who underwent pancreaticoduodenectomy (1990-2008). Univariate and multivariate analysis was performed. %26lt;br%26gt;Fifty-nine patients (46.5 %) were pN0, whereas 68 patients (53.5 %) were pN1. The 5-year disease-specific survival (DSS) was worse for pN1 patients than for pN0 patients (46 vs. 77 %; P %26lt; 0.0001). In the pN0 cohort, the optimal cut-off number of LN analyzed was found to be 12. The 5-year DSS for patients with a parts per thousand currency sign12 LN was 50 %, compared with 89 % in those with %26gt; 12 LN (P = 0.001). By multivariate analysis, a LN count %26gt; 12 was the only independent predictor associated with improved survival (HR 0.16, P = 0.003) among pN0 patients. Among pN1 patients, a LN count %26gt; 12 was associated with a significantly better 5-year DSS (59 vs. 22 %; P = 0.027). Patients with a lymph node ratio (LNR) %26gt; 0.20 had a 5-year DSS of 24 %, compared with 58 % in those with 0 %26lt; LNR a parts per thousand currency sign 0.20 (P = 0.038). %26lt;br%26gt;Removal of more than 12 LN for examination is associated with improved survival rate after surgery for AVC in both pN0 and pN1 patients.

• 出版日期2013-6