Prognostic value of para-aortic lymph node metastasis and dissection for pancreatic head ductal adenocarcinoma: a retrospective cohort study

Abstract

Background: Para-aortic lymph node (PALN) metastasis affects approximately 20% of patients with pancreatic ductal adenocarcinoma (PDAC). However, the prognostic significance of PALN metastases and dissection remain unclear. Methods: This retrospective cohort study included patients with PDAC of the pancreatic head who had undergone pancreaticoduodenectomy (PD) at our center between January 2017 and December 2020. Results: A total of 234 patients were included in the study. PALN dissection improved the median overall survival (OS) without statistical significance (24.1 vs. 18.1 months, p = 0.156). The median recurrence-free survival was significantly longer in the PALN-dissection group than the group without PALN-dissection (18.2 vs. 11.6 months, p = 0.040). Conversely, there were no significant differences in the long-term prognosis between the PALN-positive and -negative subgroups in the PALN-dissection group. Multivariate analysis showed that PALN metastasis was not an independent risk factor for OS (hazard ratio: 0.831, 95% confidence interval: 0.538-1.285, p = 0.406). Conclusions: For patients with pancreatic head ductal adenocarcinoma, PD with PALN-dissection may achieve survival prolongation and bridge the survival gap between patients with and without PALN metastasis without significantly increasing the perioperative risks.