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Pancreatic Cancer

The nodal dissection protocol included the ISGPS lymphadenectomy stations (5, 6, 8a, 12b-c, 13, 14a-b, and 17) extended to stations contiguous to the regional basin (8p, 12a-p, and jejunal mesentery nodes). Stations embedded in the PD specimen (13, 14a-b, 17 and jejunal mesentery LN) were defined as first nodal echelon, while stations sampled as distinct specimens (5, 6, 8a-p, 12a-b-p-c) were defined as second nodal echelon.

Systematic lymphadenectomy

Giuseppe Malleo, MD PhD

There has been long-standing debate about nodal dissection in pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC), with most studies examining the value of nodal yields, number of metastatic nodes and spatial location of metastases being conducted in the upfront surgery setting. With increasing use of a chemotherapy-first approach even in early stage PDAC, the validity of nodal parameters in post-treatment PD has been brought into question due to therapy-induced lymph node (LN) shrinkage. However, the available information is based on retrospective data or administrative registries, which only considered the number of examined and metastatic nodes, without detailed information regarding the dissection protocol and the influence of nodal metastases location. Back in 2013, corresponding to the standard lymphadenectomy definition release by the International Study Group of Pancreatic Surgery (ISGPS) and the diffusion of multi-agent chemotherapy regimens, an institutional, station-based nodal dissection protocol was established for post-neoadjuvant PD. The aim was to investigate whether the pattern of metastatic spread within the nodal basin is a superior quality metric for prognosis relative to the count-based classification system.

Dissecting the Pattern of Nodal Spread in Post-neoadjuvant Pancreatoduodenectomy

A Prospective Lymphadenectomy Protocol to Investigate the Pattern of Nodal Spread and Its Association With Oncologic Outcomes in Post-neoadjuvant Pancreatoduodenectomy

Data will be available upon reasonable request.

Rate of metastases to nodes outside the main resection specimen (stations 6,8,12)

Rate of metastases in each station included in the lymphadenectomy protocol

Overall survival from pancreatectomy stratified by nodal echelon

Recurrence-free survival from pancreatectomy stratified by nodal echelon

Overall survival from pancreatectomy stratified by nodal stations

Recurrence-free survival from pancreatectomy stratified by nodal stations

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Dissecting the Pattern of Nodal Spread in Post-neoadjuvant Pancreatoduodenectomy	NCT06135649	Pancreas Cancer Pancreatic Aden...	Systematic lymp...	-	Universita di Verona
Dissecting the Pattern of Nodal Spread in Post-neoadjuvant Pancreatoduodenectomy	NCT06135649	Pancreas Cancer Pancreatic Aden...	Systematic lymp...	-	Universita di Verona

Spots Global Cancer Trial Database for systematic lymphadenectomy