Department of Organ Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet Blegdamsvej 9, Copenhagen, 2100, Denmark.
Center for Surgical Translation and Artificial Intelligence Research (CSTAR), Copenhagen University Hospital, Rigshospitalet, Denmark.
BMC Surg. 2023 Aug 1;23(1):214. doi: 10.1186/s12893-023-02123-2.
For PDAC patients undergoing resection, it remains unclear whether metastases to the paraaortic lymph nodes (PALN+) have any prognostic significance and whether metastases should lead to the operation not being carried out. Our hypothesis is that PALN + status would be associated with short overall survival (OS) compared with PALN-, but longer OS compared with patients undergoing surgical exploration only (EXP).
Patients with registered PALN removal from the nationwide Danish Pancreatic Cancer Database (DPCD) from May 1st 2011 to December 31st 2020 were assessed. A cohort of PDAC patients who only had explorative laparotomy due to non-resectable tumors were also included (EXP group). Survival analysis between groups were performed with cox-regression in a multivariate approach including relevant confounders.
A total of 1758 patients were assessed, including 424 (24.1%) patients who only underwent explorative surgery leaving 1334 (75.8%) patients for further assessment. Of these 158 patients (11.8%) had selective PALN removal, of whom 19 patients (12.0%) had PALN+. Survival analyses indicated that explorative surgery was associated with significantly shorter OS compared with resection and PALN + status (Hazard Ratio 2.36, p < 0.001). No difference between PALN + and PALN- status could be demonstrated in resected patients after controlling for confounders.
PALN + status in patients undergoing resection offer improved survival compared with EXP. PALN + should not be seen as a contraindication for curative intended resection.
对于接受切除术的 PDAC 患者，转移至腹主动脉旁淋巴结（PALN+）是否具有预后意义以及转移是否应导致手术无法进行仍不清楚。我们的假设是，与 PALN-相比，PALN+状态与总生存期（OS）较短相关，但与仅接受手术探查的患者（EXP）相比，OS 更长。
评估了从 2011 年 5 月 1 日至 2020 年 12 月 31 日在全国丹麦胰腺癌症数据库（DPCD）中注册的接受 PALN 切除的患者。还纳入了仅因不可切除肿瘤而接受剖腹探查术的 PDAC 患者队列（EXP 组）。通过 Cox 回归在多变量方法中对各组之间的生存分析进行了评估，包括相关混杂因素。
共评估了 1758 名患者，其中 424 名（24.1％）患者仅接受了探查性手术，其余 1334 名（75.8％）患者进一步评估。其中 158 名（11.8％）患者接受了选择性 PALN 切除术，其中 19 名（12.0％）患者 PALN+。生存分析表明，与切除术和 PALN+状态相比，探索性手术与明显较短的 OS 相关（风险比 2.36，p<0.001）。在控制混杂因素后，在接受切除术的患者中，无法证明 PALN+状态与 PALN-状态之间存在差异。
与 EXP 相比，接受切除术的患者中 PALN+状态提供了更好的生存。PALN+不应被视为根治性切除术的禁忌症。
