Lilian Schwarz1,2, Pauline Tortajada1,3, Gabriella Pittau3, Frederic Di Fiore2,4, David Sefrioui2,4, Valérie Bridoux1, Andrea Laurenzi3, Jean-Jacques Tuech1,2, Antonio Sa Cunha3. 1. 1 Department of Digestive Surgery, Rouen University Hospital, Rouen, France. 2. 2 Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, UNIROUEN, UMR 1245 INSERM, Rouen University Hospital, Normandie University, Rouen, France. 3. 3 Department of HPB Surgery and Transplantation, Hôpital Paul Brousse, Aphp, Villejuif, France. 4. 4 Department of Digestive Oncology, Rouen University Hospital, Rouen, France.
Abstract
Background: In the setting of pancreatic ductal adenocarcinoma (PDAC), para-aortic lymph node (PALN) involvement is considered as a metastasis disease. To date, no morphological examination can effectively identify lymph node metastasis, and a significant number of patients undergo futile invasive laparotomy for PALN involvement. From an oncological point of view, laparoscopy represents a better approach for PALN sampling. The main aim of the study is to propose a laparoscopic PALN sampling first approach. We describe the surgical technique and demonstrate its technical feasibility as a routine approach as the first surgical step before pancreaticoduodenectomy for localized PDAC. Materials and Methods: During a first step of staging laparoscopy, PALN sampling was done for 31 patients with localized PDAC between November 2015 and February 2017. Demographic data and intraoperative, postoperative, and pathological criteria were evaluated. The surgical technique is described in detail. Results: The median operative time was 35 (range 18-65) minutes. The median number of PALN analyzed per patient was 2 (range 1-5). Four (13%) of 31 patients had positive PALN in frozen section analysis. No severe complication was reported for patients with positive PALN, receiving laparoscopic exploration and PALN sampling. The median hospital stay for patients with positive PALN was 2 (range 1-7) days. Conclusion: To avoid futile laparotomy, a staging laparoscopy is usually carried out. We report the feasibility and safety of laparoscopic PALN sampling and suggest its systematic realization during staging laparoscopy as a first step in patients with localized PDAC before pancreaticoduodenectomy.
Background: In the setting of pancreatic ductal adenocarcinoma (PDAC), para-aortic lymph node (PALN) involvement is considered as a metastasis disease. To date, no morphological examination can effectively identify lymph node metastasis, and a significant number of patients undergo futile invasive laparotomy for PALN involvement. From an oncological point of view, laparoscopy represents a better approach for PALN sampling. The main aim of the study is to propose a laparoscopic PALN sampling first approach. We describe the surgical technique and demonstrate its technical feasibility as a routine approach as the first surgical step before pancreaticoduodenectomy for localized PDAC. Materials and Methods: During a first step of staging laparoscopy, PALN sampling was done for 31 patients with localized PDAC between November 2015 and February 2017. Demographic data and intraoperative, postoperative, and pathological criteria were evaluated. The surgical technique is described in detail. Results: The median operative time was 35 (range 18-65) minutes. The median number of PALN analyzed per patient was 2 (range 1-5). Four (13%) of 31 patients had positive PALN in frozen section analysis. No severe complication was reported for patients with positive PALN, receiving laparoscopic exploration and PALN sampling. The median hospital stay for patients with positive PALN was 2 (range 1-7) days. Conclusion: To avoid futile laparotomy, a staging laparoscopy is usually carried out. We report the feasibility and safety of laparoscopic PALN sampling and suggest its systematic realization during staging laparoscopy as a first step in patients with localized PDAC before pancreaticoduodenectomy.
Authors: Lan Thi Nguyen; Hung Van Nguyen; Dang Hai Do; Khiem Thanh Nguyen; Anh Tuan Do; Ha Hoang Pham; Chinh Duc Nguyen Journal: Ann Med Surg (Lond) Date: 2021-05-01