Abstract
Introduction
The role of paraaortic lymphadenectomy for cancer of the pancreatic head is controversial.
The aim of this study is to analyze the prognostic role of paraaortic lymph node (PALN)
metastases after resection for ductal adenocarcinoma of the pancreatic head.
Materials and methods
A retrospective analysis of all patients, who underwent upfront resection for ductal
adenocarcinoma of the pancreatic head at the Frankfurt University Hospital from 2011
to 2020 was performed. The primary endpoint was survival, according to the presence
of PALN metastases.
Results
Out of 468 patients with pancreatic resection, 148 had an upfront resection for ductal
adenocarcinoma. Of those, in 125 (85%) a paraaortic lymphadenectomy was performed.
In 19 (15.2%) PALN metastases were detected. The estimated overall median survival
after resection was 21.7 months (95% CI 18.8 to 26.4), the disease free survival 16
months (95% CI 12 to 18). Among the patients with lymph node metastases, PALN metastases
had no significant influence on overall (18.9 versus 19 months, HR = 1.3, 95% CI 0.7
to 2.6, p = 0.392) or disease free survival (14 versus 10.7 months, HR = 1.7, 95%
CI 0.9 to 3.2, p = 0.076). After adjusting for T-stage, N-stage, grade, resection
margin, PALN metastases, and adjuvant therapy, only adjuvant therapy had a prognostic
significance for overall survival (HR = 0.47, 95% CI 0.26 to 0.85, p = 0.013).
Conclusion
Patients with ductal adenocarcinoma of the pancreatic head and PALN metastases do
not have inferior outcomes than those with regional lymph node metastases. Thus, positive
PALN should not be considered a contraindication for resection.
Keywords
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Article info
Publication history
Published online: December 23, 2022
Accepted:
December 22,
2022
Received in revised form:
December 13,
2022
Received:
October 7,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
☆The study was approved by the ethics committee of the Faculty of Medicine, Goethe-University Frankfurt, Germany (Reference number 2022-878).
Identification
Copyright
© 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
