Lymph node involvement and pancreatic resection: correlation with prognosis and local disease control in a clinical trial.

In a prospectively randomized trial evaluating pancreatic resection with adjuvant radiotherapy (intraoperative radiotherapy [IORT] vs. external beam radiotherapy [EBRT]), lymph nodal involvement was examined and correlated with outcome. Twenty-six patients underwent pancreatic resection and received either IORT or EBRT (Stages II-IV). Patients who were stage I received surgery alone. Regional nodal metastases were present in 15 of 26 (57%) patients. Seven patients suffered treatment-related mortality. Survival, mortality, and morbidity were unaffected by the type of radiotherapy. The survival of patients with negative nodes (median survival 24 months, range 10 to > 109) appeared superior to the survival of patients with nodal involvement (median survival 11.5 months; range 4-39). Even in patients with locally advanced disease extending into extrapancreatic tissues, two node-negative patients appeared to survive longer (12 and 53 months) than 10 node-positive patients with similarly extensive local disease (median survival 11.5 months; range 4-39). Local disease control, however, appeared to be independent of nodal involvement, with eventual local recurrences in 6 of 8 node-negative patients and in 4 of 7 node-positive patients who were evaluable for local disease control by autopsy or by antemortem laparotomy.