Para-aortic lymph node involvement should not be a contraindication to resection of pancreatic ductal adenocarcinoma

BACKGROUND Para-aortic lymph nodes(PALN)are found in the aortocaval groove and they are staged as metastatic disease if involved by pancreatic ductal adenocarcinoma(PDAC).The data in the literature is conflicting with some studies having associated PALN involvement with poor prognosis,while others not sharing the same results.PALN resection is not included in the standard lymphadenectomy during pancreatic resections as per the International Study Group for Pancreatic Surgery and there is no consensus on the management of these cases.AIM To investigate the prognostic significance of PALN metastases on the oncological outcomes after resection for PDAC.METHODS This is a retrospective cohort study of data retrieved from a prospectively maintained database on consecutive patients undergoing pancreatectomies for PDAC where PALN was sampled between 2011 and 2020.Statistical comparison of the data between PALN+and PALN-subgroups,survival analysis with the Kaplan-Meier method and risk analysis with univariable and multivariable time to event Cox regression analysis were performed,specifically assessing oncological outcomes such as median overall survival(OS)and disease-free survival(DFS).RESULTS 81 cases had PALN sampling and 17(21%)were positive.Pathological N stage was significantly different between PALN+and PALN-patients(P=0.005),while no difference was observed in any of the other characteristics.Preoperative imaging diagnosed PALN positivity in one case.OS and DFS were comparable between PALN+and PALN-patients with lymph node positive disease(OS:13.2 mo vs 18.8 mo,P=0.161;DFS:13 mo vs 16.4 mo,P=0.179).No difference in OS or DFS was identified between PALN positive and negative patients when they received chemotherapy either in the neoadjuvant or in the adjuvant setting(OS:23.4 mo vs 20.6 mo,P=0.192;DFS:23.9 mo vs 20.5 mo,P=0.718).On the contrary,when patients did not receive chemotherapy,PALN disease had substantially shorter OS(5.5 mo vs 14.2 mo;P=0.015)and DFS(4.4 mo vs 9.8 mo;P<0.001).PALN involvement was not identified as an independent predictor for OS after multivariable analysis,while it was for DFS doubling the risk of recurrence.CONCLUSION PALN involvement does not affect OS when patients complete the indicated treatment pathway for PDAC,surgery and chemotherapy,and should not be considered as a contraindication to resection.

Clinical Significance of Lymph Node Sampling in Endometrial Carcinoma

OBJECTIVE To study the clinical significance of pelvic and para-aortic lymph node sampling in endometrial carcinoma.METHODS Data were analyzed from 311 patients who received surgical treatment in our hospital during the period from January 1995 to December 2002.Among the patients,197 underwent lymph node sampling or lymph-adenectomy.The patients were divided into 2 groups based on the nature of their lymph node dissection,i.e.a)The sampling group included 114 patients with an extrafascial hysterectomy or modified radical hysterectomy plus pelvic or paraaortic lymph node sampling of the abdominal aorta;b)The dis-section group,included 83 patients with a radical or modified radical hyster-ectomy plus systemic pelvic lymph node clearance or paraaortic lymph node dissection of the abdominal aorta.RESULTS The median of the sampling sites for lymph node removal was 5 in the sampling group,and the median of the lymph nodes removed was 15 per case.Lymph node metastasis was found in 8 cases.In the dissection group,the median of the cases for lymph node removal was 8,and the me-dian of the lymph nodes removed was 27 per case.Lymph node metastasis was found in 6 cases.The 5-year survival rates were 90.2% and 90.9% in the 2 groups,respectively.CONCLUSION Lymph node sampling of endometrial cancer is a good way of precisely finding lymphatic metastases,and is suitable for surgical staging without causing immoderate surgical treatment and without affecting the survival rate.