TY - JOUR

T1 - Impact of para aortic lymph node removal on survival following resection for pancreatic adenocarcinoma

AU - Sillesen, Martin

AU - Hansen, Carsten Palnæs

AU - Burgdorf, Stefan Kobbelgaard

AU - Dencker, Emilie Even

AU - Krohn, Paul Suno

AU - Gisela Kollbeck, Sophie Louise

AU - Stender, Mogens Tornby

AU - Storkholm, Jan Henrik

N1 - 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).

PY - 2023

Y1 - 2023

N2 - 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.

AB - 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.

KW - Long term survival

KW - Lymph station 16

KW - Pancreatic cancer

U2 - 10.1186/s12893-023-02123-2

DO - 10.1186/s12893-023-02123-2

M3 - Journal article

C2 - 37528360

AN - SCOPUS:85166071336

VL - 23

JO - BMC Surgery

JF - BMC Surgery

SN - 1471-2482

IS - 1

M1 - 214

ER -