Para-aortic node involvement is not an independent predictor of survival after resection for pancreatic cancer

Abstract

AIMTo analyze the importance of para-aortic node status in a series of patients who underwent pancreaticoduodenectomy (PD) in a single Institution.METHODSBetween January 2000 and December 2012, 151 patients underwent PD with para-aortic node dissection for pancreatic adenocarcinoma in our Institution. Patients were divided into two groups: patients with negative PALNs (PALNs-), and patients with metastatic PALNs (PALNs+). Pathologic factors, including stage, nodal status, number of positive nodes and lymph node ratio, invasion of para-aortic nodes, tumor’s grading, and radicality of resection were studied by univariate and multivariate analysis. Survival curves were constructed with Kaplan-Meier method and compared with Log-rank test: significance was considered as P < 0.05.RESULTSA total of 107 patients (74%) had nodal metastases. Median number of pathologically assessed lymph nodes was 26 (range 14-63). Twenty-five patients (16.5%) had para-aortic lymph node involvement. Thirty-three patients (23%) underwent R1 pancreatic resection. One-hundred forty-one patients recurred and died for tumor recurrence, one is alive with recurrence, and 9 are alive and free of disease. Overall survival was significantly influenced by grading (P = 0.0001), radicality of resection (P = 0.001), stage (P = 0.03), lymph node status (P = 0.04), para-aortic nodes metastases (P = 0.02). Multivariate analysis showed that grading was an independent prognostic factor for overall survival (P = 0.0001), while grading (P = 0.0001) and radicality of resection (P = 0.01) were prognostic parameters for disease-free survival. Number of metastatic nodes, node ratio, and para-aortic nodes involvement were not independent predictors of disease-free and overall survival.CONCLUSIONIn this experience, lymph node status and para-aortic node metastases were associated with poor survival at univariate analysis, but they were not independent prognostic factors.

Para-aortic lymph node involvement should not be a contraindication to resection of pancreatic ductal adenocarcinoma

“…The survival benefit of completion of the treatment pathway (surgery and chemotherapy) in patients with PDAC is well established and the sequence of chemotherapy is based on preoperative staging (neoadjuvant or adjuvant setting)[ 31 , 32 ]. With regards to PALN involvement, this is further supported by the results of this study as well as others on PALN disease[ 20 , 33 , 34 ]. Therefore, the comparable OS and DFS after completion of the whole treatment, surgery and chemotherapy, suggest that PALN should not be considered as a contraindication for resection if identified intra-operatively.…”

Clinical Impact of Unexpected Para-Aortic Lymph Node Metastasis in Surgery for Resectable Pancreatic Cancer

“…In PC, the prognostic role of distant metastasis has been well established in various studies [13][14][15]. Nevertheless, the prognostic value of PALN metastasis has not been firmly established [9][10][11]16,17]. When unexpected PALN enlargement is found during curative resection of PC, there is no consensus on whether additional treatment strategies will be implemented.…”

Clinical Impact of Unexpected Para-Aortic Lymph Node Metastasis in Surgery for Resectable Pancreatic Cancer

“…Nevertheless, Alexandre Doussot reported that frozen sections of PALN yielded accurate PALN assessment 13,[24][25][26] .…”