Survival advantage with para aortic lymphadenectomy in peri-ampullary cancer: A retrospective cohort study.
BACKGROUND
Metastatic para aortic lymph nodes (PALN) in patients with peri ampullary cancer entail poor prognosis. Role of curative surgery in these patients remains debatable. The objective of the current study was to evaluate outcome after extended pancreaticoduodenectomy (PD) in patients with and without positive PALN.


METHODS
We reviewed 65 patients who underwent extended PD with PALN removal between 2011 and 2014. Patients were divided into two groups; those with positive PALN and those without. Patients were sub classified for pancreatic and non-pancreatic cancer. Outcome was determined based on median and estimated 3 year overall survival.


RESULTS
Median age was 57 (32-85) years. PALN were involved in 15 (23%) patients. Overall 3 year survival for patients with and without positive PALN was 60% and 54% (P = 0.7). Significant difference in survival was present between patients with pancreatic cancer and positive PALN [9 (3-12) months] versus non-pancreatic cancers with positive PALN [17.5 (13-38) months] (P = 0.02). Four out of five patients with pancreatic cancer and positive PALN had survival >6 months and 3 out of these 5 patients were alive at the last follow up.


CONCLUSIONS
Curative surgery may benefit some patients with pancreatic cancer and positive PALN and should be considered selectively.
Department of HPB and Liver Transplantation, Shifa International Hospital, Islamabad, Pakistan. Electronic address: abubakar.hafeez@yahoo.com.
Abu Bakar
AB
Hafeez Bhatti
Department of HPB and Liver Transplantation, Shifa International Hospital, Islamabad, Pakistan.
Faisal Saud
FS
Dar
Department of HPB and Liver Transplantation, Shifa International Hospital, Islamabad, Pakistan.
Eraj
E
Sahaab
Department of HPB and Liver Transplantation, Shifa International Hospital, Islamabad, Pakistan.
Nusrat Yar
NY
Khan
Department of HPB and Liver Transplantation, Shifa International Hospital, Islamabad, Pakistan.
Haseeb
H
Zia
Department of Radiology, Shifa International Hospital, Islamabad, Pakistan.
Atif
A
Rana
Department of Gastroenterology and Hepatology, Shifa International Hospital, Pakistan.
Muhammad
M
Salih
Department of Gastroenterology and Hepatology, Shifa International Hospital, Pakistan.
Najmul Hassan
NH
Shah
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery; D001011:Aorta; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods* / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis
Lymphadenectomy; Outcome; Pancreaticodoudenctomy; Survival