Unexpected Para-aortic Lymph Node Metastasis in Pancreatic Ductal Adenocarcinoma: a Contraindication to Resection?

  • Ji Su Kim
  • Ho Kyoung Hwang
  • Woo Jung Lee
  • Chang Moo KangEmail author
Original Article



Margin-negative resection is the only cure for pancreatic cancer. However, para-aortic lymph node metastasis is considered a contraindication to curative resection in pancreatic cancer. To determine if there are long-term survival differences according to the presence or absence of para-aortic lymph node metastasis in patients undergoing pancreatectomy, we evaluated oncologic outcomes in resected pancreatic cancer with unexpected para-aortic lymph node metastasis confirmed on intraoperative frozen section biopsy.


We retrospectively investigated 362 patients with pathologically confirmed pancreatic ductal adenocarcinoma who underwent pancreatectomy between 1996 and 2016.


Patients with a metastatic para-aortic lymph node had the poorest median disease-specific survival [hazard ratio 14, 95% confidence interval 10–19]. However, after chemotherapy, patients with a metastatic para-aortic lymph node had a much higher disease-specific survival rate (para-aortic lymph node+/postoperative chemotherapy− versus para-aortic lymph node+/postoperative chemotherapy+, P = 0.0003, adjusted P = 0.0015). Patients with a metastatic para-aortic lymph node who underwent postoperative chemotherapy had a similar survival benefit to patients with metastatic regional lymph node without para-aortic lymph node metastasis, regardless of postoperative chemotherapy (para-aortic lymph node+/postoperative chemotherapy+ versus regional lymph node+/postoperative chemotherapy−, P = 0.3047, adjusted P > 0.9999; para-aortic lymph node+/postoperative chemotherapy+ versus regional lymph node+/postoperative chemotherapy+, P = 0.0905, adjusted P = 0.4525).


Unexpected para-aortic lymph node metastasis on frozen section biopsy may no longer be a contraindication to curative resection in “resectable” pancreatic ductal adenocarcinoma, as long as postoperative adjuvant chemotherapy can be administered.


Pancreatic cancer Resection margin Lymph nodes Adjuvant chemotherapy 



We wish to thank Mrs. Lee EJ and Mrs. Kim HY from the Department of Biomedical Systems Informatics, Yonsei University College of Medicine, for participating in this study. We would like to thank Editage ( for English language editing.

Author Contributions

(I) Conception and design: Ji Su Kim, Chang Moo Kang, (II) Administrative support: Chang Moo Kang, (III) Provision of study material or patients: Ho Kyoung Hwang, Woo Jung Lee, Chang Moo Kang, (IV) Collection and assembly of data: Ji Su Kim, Chang Moo Kang, (V) Data analysis and interpretation: Ji Su Kim, Chang Moo Kang, (VI) Manuscript writing: All authors, (VII) Final approval of manuscript: All authors

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Division of Hepatobiliary and Pancreatic Surgery, Department of SurgeryYonsei University College of MedicineSeoulKorea
  2. 2.Pancreatobiliary Cancer CenterYonsei Cancer Center, Severance HospitalSeoulKorea

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