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

Martin Sillesen*, Carsten Palnæs Hansen, Stefan Kobbelgaard Burgdorf, Emilie Even Dencker, Paul Suno Krohn, Sophie Louise Gisela Kollbeck, Mogens Tornby Stender, Jan Henrik Storkholm


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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.
TidsskriftBMC Surgery
StatusUdgivet - 1 aug. 2023

Bibliografisk note

Funding Information:
Open access funding provided by Royal Library, Copenhagen University Library. The study was funded by a grant from the Novo Nordisk Foundation (#NNF19OC0055183) to MS.

Publisher Copyright:
© 2023, The Author(s).


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