title: Pancreatectomy with Para-Aortic Lymph Node Dissection for Pancreatic Head Adenocarcinoma: Pattern of Nodal Metastasis Spread and Analysis of Prognostic Factors.
abstract: BACKGROUND
  This study investigated the prognostic impact of the exact location of nodal metastases in a subgroup of patients who underwent pancreatectomy with extended lymphadenectomy for head adenocarcinoma, with a special focus on station 16b1.
  
  
  METHODS
  Clinical, pathologic, and follow-up details were extracted from our database and analyzed retrospectively. Survival analysis was performed using univariate and multivariate models. We also performed a matched case-control analysis with resected patients who did not receive extended lymphadenectomy and with locally advanced patients.
  
  
  RESULTS
  The study population consisted of 67 patients. The rate of station 16b1 metastases was 20.9%. Station 14a-b metastases (OR = 4.28), G3 tumors (OR = 4.03), and number of PLN ≥ 8 (OR = 4.46) were independently associated with station 16b1 involvement. Among pN1 patients, station 14a-b (HR = 2.60) and station 16b1 metastases (HR = 2.40) were predictors of survival. The median disease-specific survival of 16b1+ patients was 17 months (95% CI 8.47-25.52). In the matched case-control analysis, the survival rates of resected 16b1+ patients was in between pN1/16b1- patients and locally advanced patients.
  
  
  CONCLUSIONS
  Metastases to station 16b1 are associated with a decreased survival in comparison with pN1/16b1- patients, yet longer than in matched locally advanced patients. Station 14 can be considered as a "junctional node" to station 16b1.
authors.affiliation: Unit of General and Pancreatic Surgery, The Pancreas Institute, G.B. Rossi Hospital, University of Verona Hospital Trust, P. Le L.A. Scuro 10, 37134, Verona, Italy, salvatore.paiella@ospedaleuniverona.it.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Paiella
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Malleo
authors.forename: Laura
authors.initials: L
authors.lastname: Maggino
authors.forename: Claudio
authors.initials: C
authors.lastname: Bassi
authors.forename: Roberto
authors.initials: R
authors.lastname: Salvia
authors.forename: Giovanni
authors.initials: G
authors.lastname: Butturini
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D001011:Aorta; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate