Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2017; 23(24): 4399-4406
Published online Jun 28, 2017. doi: 10.3748/wjg.v23.i24.4399
Para-aortic node involvement is not an independent predictor of survival after resection for pancreatic cancer
Cosimo Sperti, Mario Gruppo, Stella Blandamura, Michele Valmasoni, Gioia Pozza, Nicola Passuello, Valentina Beltrame, Lucia Moletta
Cosimo Sperti, Mario Gruppo, Michele Valmasoni, Gioia Pozza, Nicola Passuello, Valentina Beltrame, Lucia Moletta, Departments of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, 35128 Padua, Italy
Stella Blandamura, Departments of Medicine, Section of Pathology, University of Padua, 35128 Padua, Italy
Author contributions: Sperti C and Beltrame V conceived the article and drafted the manuscript; Pozza G, Passuello N and Moletta L made Literature revision; Gruppo M and Valmasoni M made statistical analysis; Blandamura S made pathological examinations; Sperti C, Valmasoni M, Pozza G, Passuello N, Beltrame V and Moletta L contributed to treatment and follow-up of patients.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewer.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: The original anonymous dataset is available on request from the corresponding Author at
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Cosimo Sperti, MD, Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Via Giustiniani 2, 35128 Padova, Italy.
Telephone: +39-04-98218845 Fax: +39-04-98218821
Received: January 19, 2017
Peer-review started: January 21, 2017
First decision: February 9, 2017
Revised: February 21, 2017
Accepted: May 19, 2017
Article in press: May 19, 2017
Published online: June 28, 2017
Processing time: 158 Days and 4.5 Hours

To analyze the importance of para-aortic node status in a series of patients who underwent pancreaticoduodenectomy (PD) in a single Institution.


Between January 2000 and December 2012, 151 patients underwent PD with para-aortic node dissection for pancreatic adenocarcinoma in our Institution. Patients were divided into two groups: patients with negative PALNs (PALNs-), and patients with metastatic PALNs (PALNs+). Pathologic factors, including stage, nodal status, number of positive nodes and lymph node ratio, invasion of para-aortic nodes, tumor’s grading, and radicality of resection were studied by univariate and multivariate analysis. Survival curves were constructed with Kaplan-Meier method and compared with Log-rank test: significance was considered as P < 0.05.


A total of 107 patients (74%) had nodal metastases. Median number of pathologically assessed lymph nodes was 26 (range 14-63). Twenty-five patients (16.5%) had para-aortic lymph node involvement. Thirty-three patients (23%) underwent R1 pancreatic resection. One-hundred forty-one patients recurred and died for tumor recurrence, one is alive with recurrence, and 9 are alive and free of disease. Overall survival was significantly influenced by grading (P = 0.0001), radicality of resection (P = 0.001), stage (P = 0.03), lymph node status (P = 0.04), para-aortic nodes metastases (P = 0.02). Multivariate analysis showed that grading was an independent prognostic factor for overall survival (P = 0.0001), while grading (P = 0.0001) and radicality of resection (P = 0.01) were prognostic parameters for disease-free survival. Number of metastatic nodes, node ratio, and para-aortic nodes involvement were not independent predictors of disease-free and overall survival.


In this experience, lymph node status and para-aortic node metastases were associated with poor survival at univariate analysis, but they were not independent prognostic factors.

Keywords: Lymphadenectomy, Pancreas, Pancreatic cancer, Pancreatectomy, Lymph node metastasis, Para-aortic nodes, Survival

Core tip: Para-aortic node involvement by pancreatic cancer is traditionally considered as an advanced disease with poor prognosis. We retrospectively examined our experience of 151 patients with pancreatic cancer who underwent resection and para-aortic lymph nodes sampling. Disease-free and overall survival were worse in patients with para-aortic nodes metastases, but multivariate analysis showed that para-aortic node involvement is not an independent prognostic factor after resection of pancreatic cancer. So, the decision to make pancreatic resection should not be based on the para-aortic node status only.