From the Guidelines
Retroperitoneal lymph nodes are considered regional lymph nodes in pancreatic cancer, as they are anatomically located in the retroperitoneal space surrounding the pancreas and are typically the first sites of lymphatic spread from pancreatic tumors. The regional retroperitoneal nodes include peripancreatic nodes, nodes along the celiac axis, superior mesenteric artery, common hepatic artery, hepatoduodenal ligament, and para-aortic nodes. In pancreatic cancer staging, involvement of these regional lymph nodes classifies the disease as N1 or N2 depending on the number of positive nodes (N1: 1-3 positive regional nodes; N2: 4 or more positive regional nodes) according to the TNM staging system 1. This lymph node status significantly impacts prognosis and treatment planning. During surgical resection of pancreatic cancer, regional lymphadenectomy is typically performed to remove these nodes for accurate staging and local disease control. The pattern of lymphatic spread follows predictable pathways based on the location of the primary tumor within the pancreas, with head tumors often spreading first to peripancreatic and superior mesenteric nodes, while body and tail tumors may initially spread to splenic hilar and celiac nodes.
Some key points to consider in the management of pancreatic cancer include:
- The only curative treatment of pancreatic cancer is radical surgery, which is mainly suitable for patients with early-stage disease, mainly stage I and some stage II 1.
- Standard lymphadenectomy comprises dissection of the lymph nodes of the hepatoduodenal ligament, the common hepatic artery, the portal vein, the right-sided celiac artery lymph node, and lymph nodes at the right half of the superior mesenteric artery 1.
- There is no evidence that extended lymphadenectomy is beneficial, and it should not be considered a routine part of the Whipple procedure outside of a clinical trial 1.
- The lymph node ratio (LNR, number of involved LN/number of examined LN) should be indicated, as an LNR ≥ 0.2 is a negative prognostic factor 1.
Overall, the management of pancreatic cancer requires a multidisciplinary approach, and the consideration of retroperitoneal lymph nodes as regional lymph nodes is crucial for accurate staging and treatment planning.
From the Research
Definition of Regional Lymph Nodes in Pancreatic Cancer
- Regional lymph nodes in pancreatic cancer are typically defined as those that are located near the primary tumor and are at high risk of metastasis.
- The specific definition of regional lymph nodes can vary depending on the location and extent of the tumor.
Role of Retroperitoneal Lymph Nodes
- Retroperitoneal lymph nodes are located in the retroperitoneum, which is a space in the abdominal cavity that contains the pancreas, kidneys, and other organs 2.
- These lymph nodes can be involved in the spread of pancreatic cancer, but they are not always considered regional lymph nodes.
- A study published in 2011 found that retroperitoneal lymph node enlargement in patients with pancreatic cancer is sometimes treated as incurable disease, but non-metastatic causes of lymphadenopathy should be considered 2.
Lymph Node Involvement in Pancreatic Cancer
- Lymph node involvement is a common feature of pancreatic cancer, and the pattern of lymph node metastasis can vary depending on the location and extent of the tumor 3.
- A study published in 2020 found that the number of resected lymph nodes is associated with improved overall survival in patients with resected pancreatic cancer, but the direct impact of lymphadenectomy on survival is still ill-defined 4.
- Another study published in 2014 found that computed tomography (CT) has a low diagnostic accuracy in assessing extra-regional lymph node metastases in pancreatic and peri-ampullary cancer 5.
Treatment of Pancreatic Cancer with Lymph Node Involvement
- The treatment of pancreatic cancer with lymph node involvement typically involves a combination of surgery, chemotherapy, and radiation therapy.
- A study published in 2014 found that adjuvant radiotherapy and lymph node dissection can improve survival in patients with pancreatic cancer treated with surgery and chemotherapy 6.
- The role of retroperitoneal lymph nodes in the treatment of pancreatic cancer is still not well defined, but they may be considered regional lymph nodes in certain cases 2, 3.