Common Hepatic Artery Lymph Node Metastasis in Pancreatic Ductal Adenocarcinoma: An analysis of actual survival

Background The common hepatic artery lymph node represents a second-echelon node for tumors in the head of the pancreas. Although early studies suggested survival was comparable between the common hepatic artery lymph node and remote metastasis in pancreatic ductal adenocarcinoma, whether the lymph node is associated with adverse survival remains equivocal. Here, we examined a prospective cohort of patients calculating actual survival to better understand implications of this specific lymph node metastasis. Methods We studied 215 patients with pancreatic head pancreatic ductal adenocarcinoma, who underwent pancreaticoduodenectomies at a single institution from 2010 to 2017 wherein the common hepatic artery lymph nodes were excised. We performed actual and actuarial overall survival and disease-free survival analyses, with subsequent univariate and multivariate analyses in node-positive patients. Results Of this cohort, 7.3% of patients had involvement of the common hepatic artery lymph node, and all of them had metastatic spread to first echelon nodes. Actual median survival of patients with no lymph node involvement was 49 months. In patients with any nodal involvement, the survival was no different when comparing the lymph node positive and negative (13 and 20 months, respectively). Univariate and multivariate analyses likewise attached no significance to the lymph node metastasis, while demonstrating worse survival with positive margin status and poorly differentiated histology. Our disease-free survival analyses yielded similar results. Conclusions We found no difference in actual survival in node-positive patients regardless of the common hepatic artery lymph node involvement and recommend against its assessment in prognosticating survival or guiding surgical treatment.