The Prognostic Role of Para-Aortic Lymph Node Metastasis in Patients with Resected Pancreatic Adenocarcinoma

Brunner M, Kitzke L, Mittelstädt A, Merkel S, Weber G, Grützmann R, Krautz C (2025)

Publication Type: Journal article

Publication year: 2025

Journal

Cancers MDPI

Book Volume: 17

Article Number: 3418

Journal Issue: 21

DOI: 10.3390/cancers17213418

Abstract

Background: This study aimed to evaluate the prognostic significance of para-aortic lymph node dissection (PALND) during pancreatic head resection and the impact of para-aortic lymph node metastasis (PALN+) on survival outcomes in patients with resected pancreatic ductal adenocarcinoma (PDAC). Methods: A retrospective analysis was conducted on 198 patients who underwent primary pancreatic head resection for PDAC at the University Hospital Erlangen between 2003 and 2022. Patients were stratified based on the presence or absence of PALND and PALN metastases, and their clinicopathological characteristics and survival outcomes were compared. Results: Of the 198 patients, 113 (57%) underwent additional PALND. PALND itself had no significant impact on overall survival (OS) or disease-free survival (DFS) compared to those without PALND. Among patients who underwent PALND, 17 (15%) had PALN metastases (PALN+). PALN+ patients exhibited significantly worse pathological features, including a higher rate of regional lymph node metastases (pN+), lymphovascular invasion (L1) and vascular invasion (V1). Survival analysis showed that PALN+ was associated with significantly poorer OS (8.7 vs. 29.3 months, p < 0.001) and DFS (3.8 vs. 17.0 months, p < 0.001). In multivariate analysis, PALN+ was confirmed as an independent prognostic factor for both OS (HR 1.9 [1.0–3.6], p = 0.035) and DFS (HR 2.2 [1.2–4.0], p = 0.006). Conclusions: While PALND does not impact survival outcomes in PDAC, it plays a crucial role in identifying PALN+ patients, who have significantly worse prognoses. PALN status should be integrated into clinical decision-making, particularly when considering intensified adjuvant therapy.

Authors with CRIS profile

Maximilian Brunner Department of Surgery Lena Kitzke Graduiertenzentrum der FAU Anke Mittelstädt Department of Surgery Susanne Merkel Department of Surgery Georg Weber Department of Surgery Robert Grützmann Lehrstuhl für Allgemein- und Viszeralchirurgie Christian Krautz Department of Surgery

How to cite

APA:

Brunner, M., Kitzke, L., Mittelstädt, A., Merkel, S., Weber, G., Grützmann, R., & Krautz, C. (2025). The Prognostic Role of Para-Aortic Lymph Node Metastasis in Patients with Resected Pancreatic Adenocarcinoma. Cancers, 17(21). https://doi.org/10.3390/cancers17213418

MLA:

Brunner, Maximilian, et al. "The Prognostic Role of Para-Aortic Lymph Node Metastasis in Patients with Resected Pancreatic Adenocarcinoma." Cancers 17.21 (2025).

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