Abstract
Background: The aim of this study was to describe the predictive value of hepatic artery lymph node(HALN) metastasis compared to peripancreatic lymph node (PPLN) in overall survival (OS) and disease-free survival(DFS) of those patients who underwent pancreaticoduodenectomy(PD) for pancreatic adenocarcinoma(PA). Methods: A single-center retrospective study which analyze prospectively those patients who underwent PD for PA between 2003 and 2014.Patients were included if during PD the HALN was submitted for pathologic evaluation and with at least one year of follow-up.Patients were excluded if margins were macroscopically positive.The median follow-up was 21 months. Results: Of the 125 who underwent PD for PA,HALN status was analyzed for 64 patients.HALN was positive in 12 patients(19%),HALN and PPLN were negative in 12 patients(19%) and 40 patients (62%) were HALN-/PPLN+.The OS at 1, 3 and 5 years was:HALN+ group 72%, 9% and 9%; HALN-/PPLN- group 91%, 70%, 47% and HALN-/PPLN+ group 68%,29%,17% respectively (p = 0.015). The DFS at 1,3 and 5 years was:HALN+ group 45%,9% and 0%; HALN-/PPLN- group 81%,38%,38% and HALN-/PPLN+ group 43%,17%,10% respectively(p = 0.05). In multivariable model, the main risk factor for OS and DFS was the PPLN involvement(HR 2.7;CI 1.05-6.93) and the adjuvant chemotherapy the main protective factor(HR 0,13;IC 0,05-0,31). Conclusion: Despite OS as DFS are significantly reduced in patients with positive HALN,multivariate model showed the PPLN status as the main factor of poor prognosis in our series.
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