Journal
EJSO
Volume 33, Issue 7, Pages 887-891Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.ejso.2007.02.037
Keywords
radical pancreatico-duodenectomy; methylene blue; Kausch-Whipple operation; survival; lymphadenectomy
Ask authors/readers for more resources
Aim: The high incidence of lymphatic and peri-neural invasion in pancreatic cancer results in poor loco-regional control. Radical pancreaticoduodenectomy may achieve better loco-regional control, but is accompanied by increasing morbidity. Our hypothesis was that if intra-operative mapping of pathological lymph nodes (LN) is technically feasible in pancreatic cancer, it would allow for selective radical resection. Methods: In an ethically approved and statistically powered feasibility study of 72 (stopped after 20% enrollment) patients with suspected pancrealic cancer undergoing resection, we injected methylene blue dye peri- and intra-tumorally and studied its progress to identify putative 'sentinel lymph node(s)'. The Kausch-Whipple procedure (or total pancreatectomy, if required) was carried out in addition to radical LN dissection, which was evaluated histopathologically according to the Japanese criteria. Results: Over 18 months, 14/16 patients prospectively recruited underwent lymph node mapping and a mean of 20 (range 11-37) LNs per patient were harvested. Methylene blue dye injection identified blue LN(s) in 4/14 patients, none of which were positive for malignant deposits, whilst 10/14 patients had LN metastases. The commonest stations for LN metastasis were 17A or B (9/10), 8A (2/10) and 6 (3/10). The median survival for the 13 patients with cancer was 22.3 months (IQR: 10.4-30 months). Conclusion: Sentinel lymph node mapping is not technically feasible in pancreatic cancer. (c) 2007 Elsevier Ltd. All rights reserved.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available