¿Es realmente la afectación del ganglio de la arteria hepática un factor de mal pronóstico en el adenocarcinoma de páncreas?

Introduction: The aim of this study is to analyze the impact of hepatic artery lymph node (HALN) involvement on the survival of patients undergoing pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PA). Methods: A single-center retrospective study analyzing patients who underwent PD for PA. Patients were included if, during PD, the HALN was submitted for pathologic evaluation. Patients were stratified by node status: PPLN-(peripancreatic lymph node)/HALN-, PPLN+/HALN-and PPLN+/HALN+. Survival analysis was estimated by the Kaplan-Meier method, and Cox regression was used for risk factors analyses. Results: Out of the 118 patients who underwent PD for PA, HALN status was analyzed in 64 patients. The median follow-up was 20 months (r: 1-159 months). HALN and PPLN were negative in 12 patients (PPLN-/HALN-, 19%), PPLN was positive and HALN negative in 40 patients (PPLN+/HALN-, 62%), PPLN and HALN were positive in 12 patients (PPLN+/HALN+, 19%) and PPLN was negative and HALN positive in 0 patients (PPLN-/HALN+, 0%). The overall 1, 3 and 5-year survival rates were statistically better in the PPLN-/HALN-group (82%, 72%, 54%) than in the PPLN+/HALN-group (68%, 29%, 21%) and the PPLN+/HALN+ group (72%, 9%, 9%, respectively) (P = .001 vs P = .007). The 1, 3 and 5-year probabilities of cumulative recurrence were also statistically better in the PPLN-/HALN-group (18%, 46%, 55%) than in the PPLN+/HALN-group (57%, 80%, 89%) and the PPLN+/HALN+ group (46%, 91%, 100%, respectively) (P =.006 vs P =.021). In the multivariate model, the main risk factor for overall survival and recurrence was lymphatic invasion, regardless of HALN status. Conclusions: In pancreatic adenocarcinoma patients with lymph node disease, survival after PD is comparable regardless of HALN status. (C) 2019 AEC. Published by Elsevier Espana, S.L.U. All rights reserved.