Postoperative prognosis of pancreatic cancer with para-aortic lymph node metastasis: A multicenter study on 822 patients

Masayuki Sho, Yoshiaki Murakami, Fuyuhiko Motoi, Sohei Satoi, Ippei Matsumoto, Manabu Kawai, Goro Honda, Kenichiro Uemura, Hiroaki Yanagimoto, Masanao Kurata, Takumi Fukumoto, Takahiro Akahori, Shoichi Kinoshita, Minako Nagai, Satoshi Nishiwada, Michiaki Unno, Hiroki Yamaue, Yoshiyuki Nakajima

Research output: Contribution to journalArticlepeer-review

40 Citations (Scopus)

Abstract

Background: The prognosis of pancreatic cancer patients with metastatic para-aortic lymph node (PALN) has been reported to be extremely poor. In general, PALN metastasis has been considered as a contraindication for pancreatic resection. The aim of this study was to reevaluate the postoperative prognostic value of PALN metastasis in pancreatic cancer and to determine the validity of pancreatic surgery. Methods: Retrospective multicenter analysis of 882 patients who have undergone curative-intent pancreatic resection with pathological evaluation of PALNs for pancreatic ductal adenocarcinoma between 2001 and 2012 was conducted. Clinicopathological data and outcomes were evaluated with univariate and multivariate analysis. Results: In total, 102 (12.4 %) patients had positive metastasis in PALN. Patients with metastatic PALN had significantly poorer survival than those without (17 vs. 23 months; p < 0.001). Multivariable analysis of 822 patients identified adjuvant chemotherapy, primary tumor status, regional lymph node metastasis, portal vein invasion, pre- and post-operative serum CA19-9 levels, and tumor grade as independent prognostic factors. In contrast, PALN metastasis did not have a significant prognostic value. Furthermore, the multivariate prognostic analysis in patients with PALN metastasis revealed that adjuvant chemotherapy and the number of metastatic PALN were significantly associated with long-term survival. Lung metastasis as initial recurrence was observed more often in patients with PALN metastasis in comparison with those without. Conclusions: Some pancreatic cancer patients with metastatic PALN may survive for longer than expected after pancreatectomy. Adjuvant chemotherapy and the number of metastatic PALN were critical factors for long-term survival of those patients.

Original languageEnglish
Pages (from-to)694-702
Number of pages9
JournalJournal of gastroenterology
Volume50
Issue number6
DOIs
Publication statusPublished - 2015 Jun 10

Keywords

  • Pancreatic cancer
  • Para-aortic lymph node metastasis
  • Postoperative prognosis

ASJC Scopus subject areas

  • Gastroenterology

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