HPB P14 Para-aortic lymph node involvement should not be a contraindication to resection of pancreatic ductal adenocarcinoma


 
 
 Para-aortic lymph node (PALN) involvement is staged as metastatic disease but the literature is conflicting with no consensus on management. Aim: To investigate the prognostic significance of PALN metastases on the oncological outcomes after resection for PDAC.
 
 
 
 A retrospective cohort study of prospectively maintained data of pancreatectomies for PDAC between 2011–2020. Statistical comparison between PALN+ and PALN- subgroups, using Kaplan-Meier and Cox regression analysis.
 
 
 
 81 cases had PALN sampling, 17 (21%) were positive. OS and DFS were comparable between PALN+ and PALN- patients (OS: 13.2 vs 18.8 months, p=0.161; DFS: 13 vs 16.4, p=0.179). No difference in OS or DFS was identified between PALN+ and PALN- patients when they received chemotherapy (neoadjuvant or adjuvant). On the contrary, when patients did not receive chemotherapy, PALN disease had substantially shorter OS (5.5 vs 14.2 months; p=0.015) and DFS (4.4 vs 9.8 months; p<0.001). PALN involvement was not identified as an independent predictor for OS after multivariable analysis, while it was for DFS doubling the risk of recurrence.
 
 
 
 PALN involvement does not affect OS when patients complete the multimodal treatment pathway and should not be considered as a contraindication to resection.
