SIGNIFICANCE OF LYMPH-NODE METASTASES IN PATIENTS WITH PANCREATIC-CANCER UNDERGOING CURATIVE RESECTION

BACKGROUND: Recent reports suggest an improved survival following rese ction for patients with pancreatic carcinoma, However, the prognosis f or patients with lymph nodes metastases remains uncertain, The purpose of this study was to determine if the presence of lymph node metastas es significantly alters survival in patients with otherwise potentiall y curable pancreatic carcinoma. PATIENTS AND METHODS: Between 1970 and 1995, 401 patients with pancreatic adenocarcinoma, including 327 pati ents with pancreatic head tumors, were evaluated and treated. RESULTS: One hundred (31%) patients underwent pancreatoduodenectomy. Operative mortality was 3% and morbidity was 22%, Median survival for 97 patien ts discharged from the hospital following resection was 14 months (ran ge 2 to 293), The estimated 1-, 2-, and 5-year survivals were 61%, 43% , and 20%, respectively, Median survival was 11.5 months (range 2 to 8 7) for patients with positive lymph nodes (0 = 56) and 24 (range 0 to 293) months for patients with negative lymph nodes (0 = 41; P = 0.0003 ), Ten patients (10%) survived longer than 5 years, and 9 (90%) of the m had-negative lymph nodes, Elderly patients (greater than or equal to 70 years) had a median survival twice as long as younger patients (24 versus 12 months, P = 0.03), CONCLUSIONS: Lymph node metastases are f ound in 56% of patients undergoing resection, Pancreatoduodenectomy ca n be performed with low operative mortality in patients of all ages, I t offers good palliation for patients with lymph nodes metastases and encouraging long-term survival rates as well as a chance for cure in p atients with negative lymph nodes. (C) 1996 by Excerpta Medica, Inc.