Impact of para aortic lymph node removal on survival following resection for pancreatic adenocarcinoma

Abstract

Introduction For PDAC patients undergoing resection, it remains unclear whether metastases to the paraaortic lymph nodes (PALN+) have any prognostic significance and whether metastases should lead to the operation not being carried out. Our hypothesis is that PALN + status would be associated with short overall survival (OS) compared with PALN-, but longer OS compared with patients undergoing surgical exploration only (EXP). Methods Patients with registered PALN removal from the nationwide Danish Pancreatic Cancer Database (DPCD) from May 1st 2011 to December 31st 2020 were assessed. A cohort of PDAC patients who only had explorative laparotomy due to non-resectable tumors were also included (EXP group). Survival analysis between groups were performed with cox-regression in a multivariate approach including relevant confounders. Results A total of 1758 patients were assessed, including 424 (24.1%) patients who only underwent explorative surgery leaving 1334 (75.8%) patients for further assessment. Of these 158 patients (11.8%) had selective PALN removal, of whom 19 patients (12.0%) had PALN+. Survival analyses indicated that explorative surgery was associated with significantly shorter OS compared with resection and PALN + status (Hazard Ratio 2.36, p < 0.001). No difference between PALN + and PALN- status could be demonstrated in resected patients after controlling for confounders. Conclusion PALN + status in patients undergoing resection offer improved survival compared with EXP. PALN + should not be seen as a contraindication for curative intended resection.

The Complexity of the Pancreatic Lymphatic System and the Key Role of Para-Aortic Lymph Node Metastasis in Pancreatic Cancer Prognosis Prediction: A Comprehensive Review

“…By selectively harvesting PALN samples from PDAC patients exhibiting elevated levels of these novel markers, clinicians can achieve a more precise staging of the disease, identifying micrometastases that might not be detectable through conventional imaging techniques. This targeted approach allows for a more tailored surgical plan, as the presence of cancer cells in the PALN could indicate a higher likelihood of systemic disease, potentially altering the decision to proceed with extensive resection [44][45][46]. Furthermore, novel marker identification in PALN can provide critical prognostic information, helping to stratify patients based on their risk and guide adjuvant therapy decisions.…”