Prognostic factors of malignant tumors in the head of pancreas after operation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

RAN Donghui , LOU Ziyan , GENG Cheng ,  XU Xinjian

Department of Pancreatic Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, P. R. China;

Corresponding author：

XU Xinjian, Email: xxj0991@163.com

Keywords：

pancreatic head cancer; ampullary cancer; lower bile duct cancer; pancreaticoduodenectomy; prognosis; review

DOI：

10.7507/1007-9424.201909055

Video：

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Objective To explore the prognostic factors of malignant tumors in ampulla, lower bile duct, head of pancreas, uncinate process, and neck of pancreas after operation.Method The recent literatures on malignant tumors in this region at home and abroad were summarized.Results The prognosis of five groups of malignant tumors in ampulla, lower bile duct, head of pancreas, uncinate process, and neck of pancreas was correlated with their origin, growth site, tumor diameter, nerve invasion, vascular invasion, lymphatic metastasis, pathological and histological classification, and cutting edge status. The different location and pathological classification of tumors made the different neurovascular invasion rate, lymphatic metastasis rate, and R0 resection rate.Conclusions By summarizing and analyzing the origin, growth site, diameter, nerve invasion, vascular invasion, lymphatic metastasis, pathological and histological classification, and cutting edge status of tumors, we can improve the clinical prediction of tumors in this region, select appropriate surgical methods before operation, and formulate more reasonable adjuvant treatment plan after operation, in order to improve the pertinence of the treatment of tumors in this region, improve the prediction, and finally better serve the clinical work.

Citation： RAN Donghui, LOU Ziyan, GENG Cheng, XU Xinjian. Prognostic factors of malignant tumors in the head of pancreas after operation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(5): 646-652. doi: 10.7507/1007-9424.201909055 Copy

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2.	Riall TS, Cameron JL, Lillemoe KD, et al. Resected periampullary adenocarcinoma: 5-year survivors and their 6- to 10-year follow-up. Surgery, 2006, 140(5): 764-772.
3.	Chandrasegaram MD, Chiam SC, Chen JW, et al. Distribution and pathological features of pancreatic, ampullary, biliary and duodenal cancers resected with pancreaticoduodenectomy. World J Surg Oncol, 2015, 13(1): 85.
4.	Bourgouin S, Ewald J, Mancini J, et al. Predictors of survival in ampullary, bile duct and duodenal cancers following pancreaticoduodenectomy: a 10-year multicentre analysis. J Gastrointest Surg, 2015, 19(7): 1247-1255.
5.	高文涛, 李海峰, 奚春华, 等. 腹腔镜下动脉优先、钩突优先入路: 一种提高胰头癌动脉周围廓清率的简易安全方法. 腹腔镜外科杂志, 2017, 22(8): 568-573.
6.	El Nakeeb A, Roshdy S, Ask W, et al. Comparative study between uncinate process carcinoma and pancreatic head carcinoma after pancreaticodudenectomy (clincopathological features and surgical outcomes). Hepatogastroenterology, 2014, 61(134): 1748-1755.
7.	Liu C, Tian X, Xie X, et al. Comparison of uncinate process cancer and non-uncinate process pancreatic head cancer. J Cancer, 2016, 7(10): 1242-1249.
8.	Hirono S, Kawai M, Okada K, et al. Pancreatic neck cancer has specific and oncologic characteristics regarding portal vein invasion and lymph node metastasis. Surgery, 2016, 159(2): 426-440.
9.	Zheng Z, Tan C, Chen Y, et al. Impact of different surgical procedures on survival outcomes of patients with adenocarcinoma of pancreatic neck. PLoS One, 2019, 14(5): e0217427.
10.	El Nakeeb A, El Sorogy M, Ezzat H, et al. Predictors of long-term survival after pancreaticoduodenectomy for peri-ampullary adenocarcinoma: a retrospective study of 5-year survivors. Hepatobiliary Pancreat Dis Int, 2018, 17(5): 443-449.
11.	Marchegiani G, Andrianello S, Malleo G, et al. Does size matter in pancreatic cancer?: reappraisal of tumour dimension as a predictor of outcome beyond the TNM. Ann Surg, 2017, 266(1): 142-148.
12.	Li D, Hu B, Zhou Y, et al. Impact of tumor size on survival of patients with resected pancreatic ductal adenocarcinoma: a systematic review and meta-analysis. BMC Cancer, 2018, 18(1): 985.
13.	Gonzalez RS, Bagci P, Basturk O, et al. Intrapancreatic distal common bile duct carcinoma: analysis, staging considerations, and comparison with pancreatic ductal and ampullary adenocarcinomas. Mod Pathol, 2016, 29(11): 1358-1369.
14.	Kurata M, Honda G, Murakami Y, et al. Retrospective study of the correlation between pathological tumor size and survival after curative resection of T3 pancreatic adenocarcinoma: proposal for reclassification of the tumor extending beyond the pancreas based on tumor size. World J Surg, 2017, 41(11): 2867-2875.
15.	de Jong MC, Li F, Cameron JL, et al. Re-evaluating the impact of tumor size on survival following pancreaticoduodenectomy for pancreatic adenocarcinoma. J Surg Oncol, 2011, 103(7): 656-662.
16.	Kim J, Reber HA, Dry SM, et al. Unfavourable prognosis associated with K-ras gene mutation in pancreatic cancer surgical margins. Gut, 2006, 55(11): 1598-1605.
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24.	Agalar C, Aysal A, Unek T, et al. The role of log odds of positive lymph nodes in predicting the survival after resection for ampullary adenocarcinoma. Pathol Oncol Res, 2019, [Epub ahead of print].
25.	Kaťuchová J, Bober J, Kaťuch V, et al. Significance of lymph node micrometastasis in pancreatic cancer patients. Eur Surg Res, 2012, 48(1): 10-15.
26.	Choi SB, Han HJ, Park P, et al. Systematic review of the clinical significance of lymph node micrometastases of pancreatic adenocarcinoma following surgical resection. Pancreatology, 2017, 17(3): 342-349.
27.	Wentz SC, Zhao ZG, Shyr Y, et al. Lymph node ratio and preoperative CA 19-9 levels predict overall survival and recurrence-free survival in patients with resected pancreatic adenocarcinoma. World J Gastrointest Oncol, 2012, 4(10): 207-215.
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32.	Pedrazzoli S, DiCarlo V, Dionigi R, et al. Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group. Ann Surg, 1998, 228(4): 508-517.
33.	Yeo CJ, Cameron JL, Sohn TA, et al. Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short-term outcome. Ann Surg, 1999, 229(5): 613-624.
34.	Farnell MB, Pearson RK, Sarr MG, et al. A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery, 2005, 138(4): 618-628.
35.	Nimura Y, Nagino M, Takao S, et al. Standard versus extended lymphadenectomy in radical pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas: long-term results of a Japanese multicenter randomized controlled trial. J Hepatobiliary Pancreat Sci, 2012, 19(3): 230-241.
36.	Woo SM, Ryu JK, Lee SH, et al. Recurrence and prognostic factors of ampullary carcinoma after radical resection: comparison with distal extrahepatic cholangiocarcinoma. Ann Surg Oncol, 2007, 14(11): 3195-3201.
37.	Kawaguchi T, Ochiai T, Ikoma H, et al. Prognostic impact of histological blood vessel invasion in patients with ampullary adenocarcinoma. Hepatogastroenterology, 2010, 57(104): 1347-1350.
38.	Asada S, Itaya H, Nakamura K, et al. Radical pancreatoduodenectomy and portal vein resection. Report of two successful cases with transplantation of portal vein. Arch Surg, 1963, 87: 609-613.
39.	Al-Haddad M, Martin JK, Nguyen J, et al. Vascular resection and reconstruction for pancreatic malignancy: a single center survival study. J Gastrointest Surg, 2007, 11(9): 1168-1174.
40.	Kanda M, Fujii T, Suenaga M, et al. Pancreatoduodenectomy with portal vein resection is feasible and potentially beneficial for elderly patients with pancreatic cancer. Pancreas, 2014, 43(6): 951-958.
41.	Katz MH, Wang H, Fleming JB, et al. Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma. Ann Surg Oncol, 2009, 16(4): 836-847.
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43.	Khorana AA, Mangu PB, Berlin J, et al. Potentially curable pancreatic cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol, 2016, 34(21): 2541-2556.
44.	Mollberg N, Rahbari NN, Koch M, et al. Arterial resection during pancreatectomy for pancreatic cancer: a systematic review and meta-analysis. Ann Surg, 2011, 254(6): 882-893.
45.	Sonohara F, Yamada S, Takami H, et al. Novel implications of combined arterial resection for locally advanced pancreatic cancer in the era of newer chemo-regimens. Eur J Surg Oncol, 2019, 45(10): 1895-1900.
46.	Del Chiaro M, Rangelova E, Halimi A, et al. Pancreatectomy with arterial resection is superior to palliation in patients with borderline resectable or locally advanced pancreatic cancer. HPB (Oxford), 2019, 21(2): 219-225.
47.	方圆, 许雪峰, 纪元, 等. 壶腹周围癌预后相关危险因素分析. 中国实用外科杂志, 2012, 32(8): 652-654, 666.
48.	Luchini C, Veronese N, Nottegar A, et al. Perineural invasion is a strong prognostic moderator in ampulla of vater carcinoma: a meta-analysis. Pancreas, 2019, 48(1): 70-76.
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50.	Reddy S, Wolfgang CL, Cameron JL, et al. Total pancreatectomy for pancreatic adenocarcinoma: evaluation of morbidity and long-term survival. Ann Surg, 2009, 250(2): 282-287.
51.	Nitecki SS, Sarr MG, Colby TV, et al. Long-term survival after resection for ductal adenocarcinoma of the pancreas. Is it really improving? Ann Surg, 1995, 221(1): 59-66.
52.	Soer E, Brosens L, van de Vijver M, et al. Dilemmas for the pathologist in the oncologic assessment of pancreatoduodenectomy specimens: an overview of different grossing approaches and the relevance of the histopathological characteristics in the oncologic assessment of pancreatoduodenectomy specimens. Virchows Arch, 2018, 472(4): 533-543.
53.	Leo JM, Kalloger SE, Peixoto RD, et al. Immunophenotyping of ampullary carcinomata allows for stratification of treatment specific subgroups. J Clin Pathol, 2016, 69(5): 431-439.
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55.	刘芳芳, 沈丹华, 王汉林, 等. 联合应用蛋白标志物鉴定壶腹癌病理亚型及其临床意义. 中华病理学杂志, 2019, 48(2): 92-97.
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1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin, 2016, 66(1): 7-30.
2. Riall TS, Cameron JL, Lillemoe KD, et al. Resected periampullary adenocarcinoma: 5-year survivors and their 6- to 10-year follow-up. Surgery, 2006, 140(5): 764-772.
3. Chandrasegaram MD, Chiam SC, Chen JW, et al. Distribution and pathological features of pancreatic, ampullary, biliary and duodenal cancers resected with pancreaticoduodenectomy. World J Surg Oncol, 2015, 13(1): 85.
4. Bourgouin S, Ewald J, Mancini J, et al. Predictors of survival in ampullary, bile duct and duodenal cancers following pancreaticoduodenectomy: a 10-year multicentre analysis. J Gastrointest Surg, 2015, 19(7): 1247-1255.
5. 高文涛, 李海峰, 奚春华, 等. 腹腔镜下动脉优先、钩突优先入路: 一种提高胰头癌动脉周围廓清率的简易安全方法. 腹腔镜外科杂志, 2017, 22(8): 568-573.
6. El Nakeeb A, Roshdy S, Ask W, et al. Comparative study between uncinate process carcinoma and pancreatic head carcinoma after pancreaticodudenectomy (clincopathological features and surgical outcomes). Hepatogastroenterology, 2014, 61(134): 1748-1755.
7. Liu C, Tian X, Xie X, et al. Comparison of uncinate process cancer and non-uncinate process pancreatic head cancer. J Cancer, 2016, 7(10): 1242-1249.
8. Hirono S, Kawai M, Okada K, et al. Pancreatic neck cancer has specific and oncologic characteristics regarding portal vein invasion and lymph node metastasis. Surgery, 2016, 159(2): 426-440.
9. Zheng Z, Tan C, Chen Y, et al. Impact of different surgical procedures on survival outcomes of patients with adenocarcinoma of pancreatic neck. PLoS One, 2019, 14(5): e0217427.
10. El Nakeeb A, El Sorogy M, Ezzat H, et al. Predictors of long-term survival after pancreaticoduodenectomy for peri-ampullary adenocarcinoma: a retrospective study of 5-year survivors. Hepatobiliary Pancreat Dis Int, 2018, 17(5): 443-449.
11. Marchegiani G, Andrianello S, Malleo G, et al. Does size matter in pancreatic cancer?: reappraisal of tumour dimension as a predictor of outcome beyond the TNM. Ann Surg, 2017, 266(1): 142-148.
12. Li D, Hu B, Zhou Y, et al. Impact of tumor size on survival of patients with resected pancreatic ductal adenocarcinoma: a systematic review and meta-analysis. BMC Cancer, 2018, 18(1): 985.
13. Gonzalez RS, Bagci P, Basturk O, et al. Intrapancreatic distal common bile duct carcinoma: analysis, staging considerations, and comparison with pancreatic ductal and ampullary adenocarcinomas. Mod Pathol, 2016, 29(11): 1358-1369.
14. Kurata M, Honda G, Murakami Y, et al. Retrospective study of the correlation between pathological tumor size and survival after curative resection of T3 pancreatic adenocarcinoma: proposal for reclassification of the tumor extending beyond the pancreas based on tumor size. World J Surg, 2017, 41(11): 2867-2875.
15. de Jong MC, Li F, Cameron JL, et al. Re-evaluating the impact of tumor size on survival following pancreaticoduodenectomy for pancreatic adenocarcinoma. J Surg Oncol, 2011, 103(7): 656-662.
16. Kim J, Reber HA, Dry SM, et al. Unfavourable prognosis associated with K-ras gene mutation in pancreatic cancer surgical margins. Gut, 2006, 55(11): 1598-1605.
17. Allen PJ, Kuk D, Castillo CF, et al. Multi-institutional validation study of the American Joint Commission on Cancer (8^th Edition) changes for T and N staging in patients with pancreatic adenocarcinoma. Ann Surg, 2017, 265(1): 185-191.
18. Hatzaras I, George N, Muscarella P, et al. Predictors of survival in periampullary cancers following pancreaticoduodenectomy. Ann Surg Oncol, 2010, 17(4): 991-997.
19. Sakata E, Shirai Y, Yokoyama N, et al. Clinical significance of lymph node micrometastasis in ampullary carcinoma. World J Surg, 2006, 30(6): 985-991.
20. 刘宁, 梁寒, 张汝鹏, 等. 淋巴结转移数目是 Vater 壶腹癌术后显著的预后指标. 中华胃肠外科杂志, 2007, 10(4): 350-352.
21. Kim H, Kwon W, Kim JR, et al. Recurrence patterns after pancreaticoduodenectomy for ampullary cancer. J Hepatobiliary Pancreat Sci, 2019, 26(5): 179-186.
22. Lino-Silva LS, Salcedo-Hernández RA, Segales-Rojas P, et al. Comparison of 3 ways of dissecting the pancreatoduodenectomy specimen and their impact in the lymph node count and the lymph node metastatic ratio. Int J Surg Pathol, 2018, 26(8): 707-713.
23. Malleo G, Maggino L, Capelli P, et al. Reappraisal of nodal staging and study of lymph node station involvement in pancreaticoduodenectomy with the Standard International Study Group of Pancreatic Surgery definition of lymphadenectomy for cancer. J Am Coll Surg, 2015, 221(2): 367-379.e4.
24. Agalar C, Aysal A, Unek T, et al. The role of log odds of positive lymph nodes in predicting the survival after resection for ampullary adenocarcinoma. Pathol Oncol Res, 2019, [Epub ahead of print].
25. Kaťuchová J, Bober J, Kaťuch V, et al. Significance of lymph node micrometastasis in pancreatic cancer patients. Eur Surg Res, 2012, 48(1): 10-15.
26. Choi SB, Han HJ, Park P, et al. Systematic review of the clinical significance of lymph node micrometastases of pancreatic adenocarcinoma following surgical resection. Pancreatology, 2017, 17(3): 342-349.
27. Wentz SC, Zhao ZG, Shyr Y, et al. Lymph node ratio and preoperative CA 19-9 levels predict overall survival and recurrence-free survival in patients with resected pancreatic adenocarcinoma. World J Gastrointest Oncol, 2012, 4(10): 207-215.
28. 方向, 麦刚, 刘忠亮, 等. 胰腺癌淋巴结转移情况对预后的影响. 肝胆胰外科杂志, 2017, 29(1): 27-31.
29. Tol JA, Gouma DJ, Bassi C, et al. Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery, 2014, 156(3): 591-600.
30. 马继春, 姚继彬, 杨健, 等. 胰腺癌患者胰腺切除术后腹主动脉旁淋巴结状态与其预后及临床病理特征的关系. 肿瘤防治研究, 2017, 44(10): 665-671.
31. Yamada S, Nakao A, Fujii T, et al. Pancreatic cancer with paraaortic lymph node metastasis: a contraindication for radical surgery? Pancreas, 2009, 38(1): e13-e17.
32. Pedrazzoli S, DiCarlo V, Dionigi R, et al. Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group. Ann Surg, 1998, 228(4): 508-517.
33. Yeo CJ, Cameron JL, Sohn TA, et al. Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and short-term outcome. Ann Surg, 1999, 229(5): 613-624.
34. Farnell MB, Pearson RK, Sarr MG, et al. A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery, 2005, 138(4): 618-628.
35. Nimura Y, Nagino M, Takao S, et al. Standard versus extended lymphadenectomy in radical pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas: long-term results of a Japanese multicenter randomized controlled trial. J Hepatobiliary Pancreat Sci, 2012, 19(3): 230-241.
36. Woo SM, Ryu JK, Lee SH, et al. Recurrence and prognostic factors of ampullary carcinoma after radical resection: comparison with distal extrahepatic cholangiocarcinoma. Ann Surg Oncol, 2007, 14(11): 3195-3201.
37. Kawaguchi T, Ochiai T, Ikoma H, et al. Prognostic impact of histological blood vessel invasion in patients with ampullary adenocarcinoma. Hepatogastroenterology, 2010, 57(104): 1347-1350.
38. Asada S, Itaya H, Nakamura K, et al. Radical pancreatoduodenectomy and portal vein resection. Report of two successful cases with transplantation of portal vein. Arch Surg, 1963, 87: 609-613.
39. Al-Haddad M, Martin JK, Nguyen J, et al. Vascular resection and reconstruction for pancreatic malignancy: a single center survival study. J Gastrointest Surg, 2007, 11(9): 1168-1174.
40. Kanda M, Fujii T, Suenaga M, et al. Pancreatoduodenectomy with portal vein resection is feasible and potentially beneficial for elderly patients with pancreatic cancer. Pancreas, 2014, 43(6): 951-958.
41. Katz MH, Wang H, Fleming JB, et al. Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma. Ann Surg Oncol, 2009, 16(4): 836-847.
42. Tang K, Lu W, Qin W, et al. Neoadjuvant therapy for patients with borderline resectable pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. Pancreatology, 2016, 16(1): 28-37.
43. Khorana AA, Mangu PB, Berlin J, et al. Potentially curable pancreatic cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol, 2016, 34(21): 2541-2556.
44. Mollberg N, Rahbari NN, Koch M, et al. Arterial resection during pancreatectomy for pancreatic cancer: a systematic review and meta-analysis. Ann Surg, 2011, 254(6): 882-893.
45. Sonohara F, Yamada S, Takami H, et al. Novel implications of combined arterial resection for locally advanced pancreatic cancer in the era of newer chemo-regimens. Eur J Surg Oncol, 2019, 45(10): 1895-1900.
46. Del Chiaro M, Rangelova E, Halimi A, et al. Pancreatectomy with arterial resection is superior to palliation in patients with borderline resectable or locally advanced pancreatic cancer. HPB (Oxford), 2019, 21(2): 219-225.
47. 方圆, 许雪峰, 纪元, 等. 壶腹周围癌预后相关危险因素分析. 中国实用外科杂志, 2012, 32(8): 652-654, 666.
48. Luchini C, Veronese N, Nottegar A, et al. Perineural invasion is a strong prognostic moderator in ampulla of vater carcinoma: a meta-analysis. Pancreas, 2019, 48(1): 70-76.
49. Schnelldorfer T, Ware AL, Sarr MG, et al. Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible? Ann Surg, 2008, 247(3): 456-462.
50. Reddy S, Wolfgang CL, Cameron JL, et al. Total pancreatectomy for pancreatic adenocarcinoma: evaluation of morbidity and long-term survival. Ann Surg, 2009, 250(2): 282-287.
51. Nitecki SS, Sarr MG, Colby TV, et al. Long-term survival after resection for ductal adenocarcinoma of the pancreas. Is it really improving? Ann Surg, 1995, 221(1): 59-66.
52. Soer E, Brosens L, van de Vijver M, et al. Dilemmas for the pathologist in the oncologic assessment of pancreatoduodenectomy specimens: an overview of different grossing approaches and the relevance of the histopathological characteristics in the oncologic assessment of pancreatoduodenectomy specimens. Virchows Arch, 2018, 472(4): 533-543.
53. Leo JM, Kalloger SE, Peixoto RD, et al. Immunophenotyping of ampullary carcinomata allows for stratification of treatment specific subgroups. J Clin Pathol, 2016, 69(5): 431-439.
54. Fernández Moro C, Fernandez-Woodbridge A, Alistair D’souza M, et al. Correction: immunohistochemical typing of adenocarcinomas of the pancreatobiliary system improves diagnosis and prognostic stratification. PLoS One, 2017, 12(1): e0171283.
55. 刘芳芳, 沈丹华, 王汉林, 等. 联合应用蛋白标志物鉴定壶腹癌病理亚型及其临床意义. 中华病理学杂志, 2019, 48(2): 92-97.
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