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The Impact of Additional Para-aortic Dissection During Pancreaticoduodenectomy for Resectable Pancreatic Cancer

  • Pancreatic Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The short-term outcome and long-term survival of pancreaticoduodenectomy with additional para-aortic dissection (PAD) for patients with resectable pancreatic cancer remain obscure.

Patients and Methods

Consecutive patients who underwent radical pancreaticoduodenectomy for resectable pancreatic cancer in a single high-volume center during a 7-year period were included retrospectively. Both short- and long-term effects of PAD were compared between the PAD group and the no PAD group. Then, the PAD group was divided into the non-metastatic para-aortic lymph node (PALN−) group and the metastatic PALN (PALN+) group to further analyze the prognosis of PALN+.

Results

Of the 909 included patients, 280 (30.8%) underwent PAD during pancreaticoduodenectomy. The PAD group had a higher rate of intra-abdominal infection compared with the no PAD group (28.6% vs. 20.7%, P = 0.009) but no differences were found in the incidence of other complications. The overall survival (OS) and recurrence-free survival (RFS) were also comparable between the two groups. Subgroup analysis showed that patients with PALN+ had a worse OS than patients in the PALN− group (median of 14 vs. 20 months, P = 0.048). Multivariate Cox regression analysis further revealed that PALN+ was an independent adverse predictor of OS (hazard ratio: 1.70, P = 0.007).

Conclusions

This study suggests that the addition of PAD during pancreaticoduodenectomy does not improve the prognosis of patients with resectable pancreatic cancer and may lead to an increased risk of infection. However, the accurate preoperative assessment and appropriate treatment strategy for patients with PALN+ need further investigation due to the poor prognosis.

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Funding

The Medical Engineering Cross Research Fund of Shanghai Jiao Tong University, YG2021QN16, Shanghai Anti-Cancer Association, SACA-CY20C02

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Author notes

  1. Ziyun Shen and Haoda Chen contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Ziyun Shen MD, Haoda Chen MD, Shiwei Zhao MD, Yuchen Ji MD, Yiran Zhou MD, Yuanchi Weng MD, Jun Zhang MD, Xiaxing Deng MD, Chenghong Peng MD, PhD, Weishen Wang MD & Baiyong Shen MD, PhD

  2. Research Institute of Pancreatic Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Chenghong Peng MD, PhD, Weishen Wang MD & Baiyong Shen MD, PhD

  3. State Key Laboratory of Oncogenes and Related Genes, Shanghai, China

    Baiyong Shen MD, PhD

  4. Institute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, China

    Baiyong Shen MD, PhD

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  1. Ziyun Shen MD
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  2. Haoda Chen MD
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Contributions

Z.S., H. C., W. W., and B. S.: study conception, design. Z. S., H. C., S.Z., Y. J., Y. W., Y. Z., J. Z., X. D., C. P., and B. S.: acquisition of data. Z. S. and H. C.: analysis and interpretation of data. Z. S. and H. C.: drafting of the manuscript. Z. S., H. C., W. W., and B. S.: critical revision. All authors contributed to the article and approved the submitted version.

Corresponding authors

Correspondence to Weishen Wang MD or Baiyong Shen MD, PhD.

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We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work, there is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled, “The Impact of Additional Para-aortic Dissection during Pancreaticoduodenectomy for Resectable Pancreatic Cancer.”

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Shen, Z., Chen, H., Zhao, S. et al. The Impact of Additional Para-aortic Dissection During Pancreaticoduodenectomy for Resectable Pancreatic Cancer. Ann Surg Oncol 30, 1474–1482 (2023). https://doi.org/10.1245/s10434-022-12700-z

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  • DOI: https://doi.org/10.1245/s10434-022-12700-z

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