title: Postoperative prognosis of pancreatic cancer with para-aortic lymph node metastasis: a multicenter study on 822 patients.
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.
authors.affiliation: Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan, m-sho@naramed-u.ac.jp.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Sho
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Murakami
authors.forename: Fuyuhiko
authors.initials: F
authors.lastname: Motoi
authors.forename: Sohei
authors.initials: S
authors.lastname: Satoi
authors.forename: Ippei
authors.initials: I
authors.lastname: Matsumoto
authors.forename: Manabu
authors.initials: M
authors.lastname: Kawai
authors.forename: Goro
authors.initials: G
authors.lastname: Honda
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Uemura
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yanagimoto
authors.forename: Masanao
authors.initials: M
authors.lastname: Kurata
authors.forename: Takumi
authors.initials: T
authors.lastname: Fukumoto
authors.forename: Takahiro
authors.initials: T
authors.lastname: Akahori
authors.forename: Shoichi
authors.initials: S
authors.lastname: Kinoshita
authors.forename: Minako
authors.initials: M
authors.lastname: Nagai
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nishiwada
authors.forename: Michiaki
authors.initials: M
authors.lastname: Unno
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Nakajima
mesh_terms: D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000379:methods; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate