Clinical Relevance of Para-Aortic Nodes Involvement in Resectable Pancreatic Cancer. A Single Center Experience

Background: according to 8th edition of AJCC classification, para-aortic nodes (PALNs) involvement in pancreatic cancer (PC) is considered as metastatic disease and, therefore, surgical resection is not recommended. However, as some series reported favourable survival results after radical surgery even in presence of metastatic PALNs (PALNs+), the matter still remains debated. Material & Methods: A retrospective analysis of our database was performed between the date September 2015 and February 2018, searching for patients undergoing pancreaticoduodenectomy for PC. Primary and secondary endpoints were overall survival (OS) and progression free-survival (PFS). Survival analysis was carried out using the Kaplan-Meier method with the log-rank test. A p-value <0.05 was considered as statistically significant. Results: 141 patients were retrieved, of whom 79 male (54.1%) and 67 female (45.9%). Mean age was 65 years (SD±10) while median preoperative CEA and CA19.9 level were 2.6 ng/mL (range: 0.4-19.7) and 109.4 U/mL (range: 0.6-974), respectively. PALNs were removed in 46 (32.6%) patients and resulted site of metastases in 13 cases (28.2%). At univariate analyses both OS and PFS resulted significantly poorer in presence of node metastases (OS: 24 vs 33 months; p=0.016; PFS: 13 vs 18 months; p=0.05) and high tumor grading (G3 vs G1-2; OS: 20 vs 34 months; p=0.033; PFS: 5 vs 13 months; p=0.034). Within the PALNs+ subgroup, median OS and PFS were 15 and 5.5 months, respectively, and the data is statistically significant if compared with PALNs- counterpart (OS: 23 months; p< 0.0001; PFS: 17 months; p=0.001) and the subgroup of patients not undergoing PALNs sampling (OS: 28 months; p=0.004; PFS: 13 months: p=0.006). Conclusions: Metastatic PALNs for PC showed to strongly correlates with a poor prognosis in our series. Frozen section analyses of PALNs should be considered before proceeding to radical surgery especially for those patients at high risk for major complications.