Background:This study aimed to evaluate the prognostic significance of para-aortic lymph node dissection (PALND) during pancreatic head resection and the impact of para-aortic lymph node metastasis (PALN+) on survival outcomes in patients with resected pancreatic ductal adenocarcinoma (PDAC).Methods:A retrospective analysis was conducted on 198 patients who underwent primary pancreatic head resection for PDAC at the University Hospital Erlangen between 2003 and 2022. Patients were stratified based on the presence or absence of PALND and PALN metastases, and their clinicopathological characteristics and survival outcomes were compared.Results:Of the 198 patients, 113 (57%) underwent additional PALND. PALND itself had no significant impact on overall survival (OS) or disease-free survival (DFS) compared to those without PALND. Among patients who underwent PALND, 17 (15%) had PALN metastases (PALN+). PALN+ patients exhibited significantly worse pathological features, including a higher rate of regional lymph node metastases (pN+), lymphovascular invasion (L1) and vascular invasion (V1). Survival analysis showed that PALN+ was associated with significantly poorer OS (8.7 vs. 29.3 months,p< 0.001) and DFS (3.8 vs. 17.0 months,p< 0.001). In multivariate analysis, PALN+ was confirmed as an independent prognostic factor for both OS (HR 1.9 [1.0–3.6],p= 0.035) and DFS (HR 2.2 [1.2–4.0],p= 0.006).Conclusions:While PALND does not impact survival outcomes in PDAC, it plays a crucial role in identifying PALN+ patients, who have significantly worse prognoses. PALN status should be integrated into clinical decision-making, particularly when considering intensified adjuvant therapy.
背景：本研究旨在评估胰头切除术中腹主动脉旁淋巴结清扫术（PALND）的预后意义，以及腹主动脉旁淋巴结转移（PALN+）对已切除胰腺导管腺癌（PDAC）患者生存结局的影响。 方法：对2003年至2022年间在埃尔朗根大学医院接受原发性胰头切除术治疗的198例PDAC患者进行回顾性分析。根据是否进行PALND及是否存在PALN转移对患者进行分层，并比较其临床病理特征和生存结局。 结果：在198例患者中，113例（57%）接受了额外的PALND。与未接受PALND的患者相比，PALND本身对总生存期（OS）或无病生存期（DFS）无显著影响。在接受PALND的患者中，17例（15%）存在PALN转移（PALN+）。PALN+患者表现出显著更差的病理特征，包括更高的区域淋巴结转移率（pN+）、淋巴血管侵犯（L1）和血管侵犯（V1）。生存分析显示，PALN+与显著更差的OS（8.7个月 vs. 29.3个月，p < 0.001）和DFS（3.8个月 vs. 17.0个月，p < 0.001）相关。在多变量分析中，PALN+被证实是OS（HR 1.9 [1.0–3.6]，p = 0.035）和DFS（HR 2.2 [1.2–4.0]，p = 0.006）的独立预后因素。 结论：虽然PALND本身不影响PDAC患者的生存结局，但它在识别预后显著更差的PALN+患者方面起着关键作用。PALN状态应纳入临床决策，尤其是在考虑强化辅助治疗时。
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