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. 2020 Jan 21;18(1):16.
doi: 10.1186/s12957-020-1783-5.

Prognostic impact of para-aortic lymph node metastases in non-pancreatic periampullary cancer

Sebastian Hempel  1 , Florian Oehme  1 , Benjamin Müssle  1 , Daniela E Aust  2 , Marius Distler  1 , Hans-Detlev Saeger  1 , Jürgen Weitz  1 , Thilo Welsch  3
Affiliations

Prognostic impact of para-aortic lymph node metastases in non-pancreatic periampullary cancer

Sebastian Hempel et al. World J Surg Oncol. .

Abstract

Background: Resection of the para-aortic lymph node (PALN) group Ln16b1 during pancreatoduodenectomy remains controversial because PALN metastases are associated with a worse prognosis in pancreatic cancer patients. The present study aimed to analyze the impact of PALN metastases on outcome after non-pancreatic periampullary cancer resection.

Methods: One hundred sixty-four patients with non-pancreatic periampullary cancer who underwent curative pancreatoduodenectomy or total pancreatectomy between 2005 and 2016 were retrospectively investigated. The data were supplemented with a systematic literature review on this topic.

Results: In 67 cases, the PALNs were clearly assigned and could be histopathologically analyzed. In 10.4% of cases (7/67), tumor-infiltrated PALNs (PALN+) were found. Metastatic PALN+ stage was associated with increased tumor size (P = 0.03) and a positive nodal stage (P < 0.001). The median overall survival (OS) of patients with metastatic PALN and non-metastatic PALN (PALN-) was 24.8 and 29.5 months, respectively. There was no significant difference in the OS of PALN+ and pN1 PALN patients (P = 0.834). Patients who underwent palliative surgical treatment (n = 20) had a lower median OS of 13.6 (95% confidence interval 2.7-24.5) months. Including the systematic literature review, only 23 cases with PALN+ status and associated OS could be identified; the average survival was 19.8 months.

Conclusion: PALN metastasis reflects advanced tumor growth and lymph node spread; however, it did not limit overall survival in single-center series. The available evidence of the prognostic impact of PALN metastasis is scarce and a recommendation against resection in these cases cannot be given.

Keywords: Non-pancreatic periampullary cancer; Pancreatoduodenectomy; Para-aortic lymph nodes; Survival.

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Conflict of interest statement

The authors declare that they have no conflicts of interest with respect to this work.

Figures

Fig. 1
Fig. 1
Overall survival of patients with para-aortic lymph node resection. a Overall survival of patients with para-aortic lymph node (PALN) resection (n = 67). Patient subgroups with PALN metastasis (PALN+, n = 7) and without PALN metastasis (PALN−, n = 60) were plotted. b Overall survival of patients with PALN resection separated into PALN+ (n = 7), PALN− pN0 (n = 29), and PALN− pN1 (n = 31) subgroups according to the regional lymph node status
Fig. 2
Fig. 2
Progression-free survival of patients with para-aortic lymph node resection. a Progression-free survival of patients with para-aortic lymph node (PALN) resection (n = 67). Patient subgroups with PALN metastasis (PALN+, n = 7) and without PALN metastasis (PALN−, n = 60) were plotted. b Progression-free survival of patients with PALN resection separated into PALN+ (n = 7), PALN− pN0 (n = 29), and PALN− pN1 (n = 31) subgroups according to the regional lymph node status
Fig. 3
Fig. 3
PRISMA flow diagram of the systematic literature search
See this image and copyright information in PMC

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