Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2022; 14(5): 429-441
Published online May 27, 2022. doi: 10.4240/wjgs.v14.i5.429
Para-aortic lymph node involvement should not be a contraindication to resection of pancreatic ductal adenocarcinoma
Rupaly Pande, Shafiq Chughtai, Manish Ahuja, Rachel Brown, David C Bartlett, Bobby V Dasari, Ravi Marudanayagam, Darius Mirza, Keith Roberts, John Isaac, Robert P Sutcliffe, Nikolaos A Chatzizacharias
Rupaly Pande, Shafiq Chughtai, Manish Ahuja, David C Bartlett, Bobby V Dasari, Ravi Marudanayagam, Darius Mirza, Keith Roberts, John Isaac, Robert P Sutcliffe, Nikolaos A Chatzizacharias, Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, United Kingdom
Rachel Brown, Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, United Kingdom
Author contributions: Pande R, Chughtai S, Ahuja M, Brown R, Chatzizacharias NA developed this protocol/project, collected data and performed the research; Pande R, Chughtai S, Ahuja M, and Chatzizacharias NA contributed analytical tools; Pande R, Chughtai S, Ahuja M, Brown R, Chatzizacharias NA, Bartlett DC, Marudanayagam R, Mirza D, Isaac J, Sutcliffe RP, and Roberts KJ analyzed the data and wrote the manuscript; all authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved for publication by the Departmental Institutional Review Board.
Informed consent statement: As this was an anonymised retrospective cohort study over a period of 10 years, individual consent forms were not required based on the policy of Queen Elizabeth Hospital and the UK on ethics and research.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available upon request from the corresponding author.
STROBE statement: the authors have reviewed the STROBE statement-checklist of items. The written material was prepared concordant with the STROBE statement-check list of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nikolaos A Chatzizacharias, FACS, FRCS, MD, PhD, Consultant Surgeon, Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham B15 2GW, United Kingdom. chatzizacharias@gmail.com
Received: December 21, 2021
Peer-review started: December 21, 2021
First decision: March 13, 2022
Revised: March 19, 2022
Accepted: April 21, 2022
Article in press: April 21, 2022
Published online: May 27, 2022
Processing time: 154 Days and 19.1 Hours
Core Tip

Core Tip: Currently there is no consensus on the prognostic significance of para-aortic lymph node (PALN) involvement in pancreatic ductal adenocarcinoma (PDAC), which is staged as metastatic disease (M1). Our study has demonstrated that patients with PALN involvement have comparable oncological outcomes, overall survival (OS) and disease free survival, to ones without PALN disease, when the appropriate treatment pathway is competed (surgery and chemotherapy). Multivariable risk analysis did not identify PALN involvement as an independent predictor for OS, while it doubled the risk of disease recurrence. Our data support that PALN involvement should not be considered a contraindication to resection for PDAC.