{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T09:36:53Z","timestamp":1794562613996,"version":"4.9.1"},"reference-count":25,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T00:00:00Z","timestamp":1761264000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>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 &lt; 0.001) and DFS (3.8 vs. 17.0 months, p &lt; 0.001). In multivariate analysis, PALN+ was confirmed as an independent prognostic factor for both OS (HR 1.9 [1.0\u20133.6], p = 0.035) and DFS (HR 2.2 [1.2\u20134.0], 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.<\/jats:p>","DOI":"10.3390\/cancers17213418","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T13:59:36Z","timestamp":1761659976000},"page":"3418","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Prognostic Role of Para-Aortic Lymph Node Metastasis in Patients with Resected Pancreatic Adenocarcinoma"],"prefix":"10.3390","volume":"17","author":[{"given":"Maximilian","family":"Brunner","sequence":"first","affiliation":[{"name":"Department of General and Visceral Surgery, University Hospital Erlangen, Friedrich-Alexander-University (FAU), Krankenhausstra\u00dfe 12, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena","family":"Kitzke","sequence":"additional","affiliation":[{"name":"Department of General and Visceral Surgery, University Hospital Erlangen, Friedrich-Alexander-University (FAU), Krankenhausstra\u00dfe 12, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1716-3547","authenticated-orcid":false,"given":"Anke","family":"Mittelst\u00e4dt","sequence":"additional","affiliation":[{"name":"Department of General and Visceral Surgery, University Hospital Erlangen, Friedrich-Alexander-University (FAU), Krankenhausstra\u00dfe 12, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2676-9486","authenticated-orcid":false,"given":"Susanne","family":"Merkel","sequence":"additional","affiliation":[{"name":"Department of General and Visceral Surgery, University Hospital Erlangen, Friedrich-Alexander-University (FAU), Krankenhausstra\u00dfe 12, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1175-4505","authenticated-orcid":false,"given":"Georg F.","family":"Weber","sequence":"additional","affiliation":[{"name":"Department of General and Visceral Surgery, University Hospital Erlangen, Friedrich-Alexander-University (FAU), Krankenhausstra\u00dfe 12, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Gr\u00fctzmann","sequence":"additional","affiliation":[{"name":"Department of General and Visceral Surgery, University Hospital Erlangen, Friedrich-Alexander-University (FAU), Krankenhausstra\u00dfe 12, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2537-5824","authenticated-orcid":false,"given":"Christian","family":"Krautz","sequence":"additional","affiliation":[{"name":"Department of General and Visceral Surgery, University Hospital Erlangen, Friedrich-Alexander-University (FAU), Krankenhausstra\u00dfe 12, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,24]]},"reference":[{"key":"ref_1","first-page":"10","article-title":"Cancer statistics, 2025","volume":"75","author":"Siegel","year":"2025","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"GBD 2017 Pancreatic Cancer Collaborators (2019). The global, regional, and national burden of pancreatic cancer and its attributable risk factors in 195 countries and territories, 1990\u20132017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol. Hepatol., 4, 934\u2013947. Erratum in: Lancet Gastroenterol. Hepatol. 2020, 5, e2. https:\/\/doi.org\/10.1016\/S2468-1253(20)30018-2.","DOI":"10.1016\/S2468-1253(20)30018-2"},{"key":"ref_3","first-page":"209","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/S0140-6736(16)00141-0","article-title":"Pancreatic cancer","volume":"388","author":"Kamisawa","year":"2016","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2395","DOI":"10.1056\/NEJMoa1809775","article-title":"FOLFIRINOX or Gemcitabine as Adjuvant Therapy for Pancreatic Cancer","volume":"379","author":"Conroy","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1097\/SLA.0000000000002234","article-title":"Patterns, Timing, and Predictors of Recurrence Following Pancreatectomy for Pancreatic Ductal Adenocarcinoma","volume":"267","author":"Groot","year":"2018","journal-title":"Ann. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/j.surg.2020.06.042","article-title":"Recurrence patterns and postrecurrence survival after curative intent resection for pancreatic ductal adenocarcinoma","volume":"169","author":"Kolbeinsson","year":"2021","journal-title":"Surgery"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/j.surg.2014.06.016","article-title":"Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: A consensus statement by the International Study Group on Pancreatic Surgery (ISGPS)","volume":"156","author":"Tol","year":"2014","journal-title":"Surgery"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1016\/j.ejso.2022.12.012","article-title":"Prognostic value of paraaortic lymph node metastases in patients with ductal adenocarcinoma of the pancreatic head","volume":"49","author":"Petrova","year":"2023","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1807","DOI":"10.1016\/j.surg.2021.06.045","article-title":"Para-aortic lymph nodes and ductal adenocarcinoma of the pancreas: Distant neighbors?","volume":"170","author":"Safi","year":"2021","journal-title":"Surgery"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Sillesen, M., Hansen, C.P., Burgdorf, S.K., Dencker, E.E., Krohn, P.S., Gisela Kollbeck, S.L., Stender, M.T., and Storkholm, J.H. (2023). Impact of para aortic lymph node removal on survival following resection for pancreatic adenocarcinoma. BMC Surg., 23.","DOI":"10.1186\/s12893-023-02123-2"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"4399","DOI":"10.3748\/wjg.v23.i24.4399","article-title":"Para-aortic node involvement is not an independent predictor of survival after resection for pancreatic cancer","volume":"23","author":"Sperti","year":"2017","journal-title":"World J. Gastroenterol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1007\/s00535-014-1005-4","article-title":"Postoperative prognosis of pancreatic cancer with para-aortic lymph node metastasis: A multicenter study on 822 patients","volume":"50","author":"Sho","year":"2015","journal-title":"J. Gastroenterol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1016\/j.ejso.2016.02.003","article-title":"The prognostic impact of para-aortic lymph node metastasis in pancreatic cancer: A systematic review and meta-analysis","volume":"42","author":"Paiella","year":"2016","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1002\/bjs.9444","article-title":"Para-aortic lymph node sampling in pancreatic head adenocarcinoma","volume":"101","author":"Schwarz","year":"2014","journal-title":"Br. J. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Brierley, J.D., Gospodarowicz, M.K., and Wittekind, C. (2017). TNM Classification of Malignant Tumours, Wiley Blackwell. [8th ed.].","DOI":"10.1002\/9780471420194.tnmc26.pub3"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1002\/jhbp.12056","article-title":"Japanese classification of pancreatic carcinoma by the Japan Pancreas Society: Eighth edition","volume":"31","author":"Ishida","year":"2024","journal-title":"J. Hepato-Biliary-Pancreat. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Hempel, S., Plodeck, V., Mierke, F., Distler, M., Aust, D.E., Saeger, H.D., Weitz, J., and Welsch, T. (2017). Para-aortic lymph node metastases in pancreatic cancer should not be considered a watershed for curative resection. Sci. Rep., 7.","DOI":"10.1038\/s41598-017-08165-w"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1055\/a-1528-7927","article-title":"Pyloruserhaltende partielle Pankreatoduodenektomie mit segmentaler Pfortaderresektion [Pylorus-Preserving Pancreaticoduodenectomy (PPPD) with Segmental Portal Vein Resection]","volume":"147","author":"Brunner","year":"2022","journal-title":"Zentralbl. Chir."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"4084","DOI":"10.1245\/s10434-024-15105-2","article-title":"Very Early Recurrence After Curative Resection for Pancreatic Ductal Adenocarcinoma: Proof of Concept for a \u201cBiological R2 Definition\u201d","volume":"31","author":"Belfiori","year":"2024","journal-title":"Ann. Surg. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2949","DOI":"10.1245\/s10434-020-08304-0","article-title":"How to Approach Para-Aortic Lymph Node Metastases During Exploration for Suspected Periampullary Carcinoma: Resection or Bypass?","volume":"27","author":"Pranger","year":"2020","journal-title":"Ann. Surg. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2789","DOI":"10.1007\/s11605-019-04483-8","article-title":"Unexpected Para-aortic Lymph Node Metastasis in Pancreatic Ductal Adenocarcinoma: A Contraindication to Resection?","volume":"24","author":"Kim","year":"2020","journal-title":"J. Gastrointest. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1245\/s10434-006-9131-8","article-title":"Pancreatic resection for M1 pancreatic ductal adenocarcinoma","volume":"14","author":"Shrikhande","year":"2007","journal-title":"Ann. Surg. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Huan, L., Yu, F., Cao, D., Zhou, H., Qin, M., and Cao, Y. (2024). Comparison of neoadjuvant treatment and surgery first for resectable or borderline resectable pancreatic carcinoma: A systematic review and network meta-analysis of randomized controlled trials. 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