title: Prognostic implication of para-aortic lymph node metastasis in resectable pancreatic cancer.
abstract: BACKGROUND
  The survival curve of patients who undergo surgical resection of pancreatic cancer displays a steep decline within 1 year and a relatively slow decline thereafter. The patients with a short survival time may have identifiable clinicopathologic factors that lead to rapid relapse.
  
  
  METHODS
  We analyzed clinicopathologic factors in 133 patients who underwent margin-negative pancreatoduodenectomy with extended radical lymphadenectomy for invasive ductal carcinoma of the pancreas to detect factors that could be responsible for the short survival.
  
  
  RESULTS
  Tumor size, invasion of the anterior pancreatic capsule, retroperitoneal invasion, portal venous invasion, major arterial invasion, and metastasis to the para-aortic lymph nodes were variables associated with survival time in univariate analysis. Metastasis to the para-aortic lymph nodes was the single independent factor with a significant association with mortality in multivariate analysis. Some 84% of the patients who had positive para-aortic lymph nodes died within 1 year, versus 46% of the patients with negative nodes.
  
  
  CONCLUSIONS
  Although tumors that involve the para-aortic lymph nodes may technically be resectable, the expected postoperative survival time for most patients is less than 1 year. If para-aortic nodal metastasis is detected, alternative treatment strategies should be considered.
authors.affiliation: Department of Surgery, Kyoto University, 54 Shogoinkawaracho, Sakyo, Kyoto, Japan. doir@kuhp.kyoto-u.ac.jp
authors.forename: Ryuichiro
authors.initials: R
authors.lastname: Doi
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kami
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ito
authors.forename: Koji
authors.initials: K
authors.lastname: Fujimoto
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Kawaguchi
authors.forename: Michihiko
authors.initials: M
authors.lastname: Wada
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kogire
authors.forename: Ryo
authors.initials: R
authors.lastname: Hosotani
authors.forename: Masayuki
authors.initials: M
authors.lastname: Imamura
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
mesh_terms: D000368:Aged; D001011:Aorta; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000473:pathology; D008297:Male; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis