Análise de metástases linfonodais em peças cirúrgicas de duodenopancreatectomia realizadas em pacientes com carcinoma da papila duodenal maior

Abstract

Introduction: Duodenal ampullary carcinoma (DAC) is a malignant neoplastic condition with potential for cure. Surgical treatment with duodenopancreatectomy (DP) yields the best outcomes in early stages. Lymphadenectomy associated with DP is under study to assess its extent, significance in staging, and clinical outcomes for DPC patients, as patient lymph node involvement (Ln+) correlates with reduced survival. Therefore, standardization and focus on relevant sites are crucial during the macroscopic phase of pathological study when searching for lymph nodes. Objective: Analyze the frequencies of Ln+ in standardized peripancreatic lymph node chains. Methods: 21 patients with DAC underwent DP between 2019 and 2023. Surgical specimens were dissected following a standardized protocol, and data were analyzed statistically. Results: Patients had a mean age of 65.24 years, predominantly female (57.1%), and of white ethnicity (66.7%). An average of 31.29 (median 30) lymph nodes per patient was analyzed. 66.6% of patients had lymph node involvement (N+). All Ln+ were distributed among only four of the nine standardized lymph node chains. The posterior inferior chain (PIC) demonstrated the most significant metastatic involvement in all methods. PIC had the highest frequency of chains with Ln+ (50%); 47.9% of the Ln+ in the sample and the highest percentage (25.3%) among Ln+/Ln studied. In cluster analysis, PIC was the strongest predictor (1.0) in patient grouping. The Chi-square test showed an association (p-value = 0.0053) between lymph node distribution in chains and lymph node status N+ or N-, with PIC contributing 51.18% to the occurrence and 22.94% to the non-occurrence of Ln+ in patients. Conclusion: Standardization of macroscopic dissection post-DP is fundamental for accurate staging of DPC. PIC proved to be statistically the most significant for Ln+ and should be routinely included in pathological studies for proper staging of DPC patients.