Lymph Node Involvement Beyond Peripancreatic Region in Pancreatic Head Cancers When Results Belie Expectations

Objectives: Surgery remains the standard therapy for curative management of pancreatic duct adenocarcinoma (PDA) involving the head of pancreas. This study aimed to report our experience in PDA about the prognostic value of lymph node (LN) invasion (N+) at the root of the superior mesenteric artery (SMA) and in N2 subgroup. Methods: From January 2005 to September 2009, 110 patients were included for pancreaticoduodenectomy or total pancreatectomy. Results: Etiologies were PDA (n = 87) or ampullary carcinomas (n = 23). Sixty-five percent of patients were N+, with N1/N2/N3 location, respectively, 63.6%, 9.1%, and 2.7%. Forty-four percent had a LN identified intraoperatively at the origin of the SMA, of whom only 12% were N+. In multivariate analysis (whole series), complication grade greater than II, location of positive LN (N1 to N3) and vascular resection were associated with a poorer survival. In the exocrine PDA subgroup, only location of positive LN and vascular resection were associated with a poorer survival. N+ SMA was not statistically correlated with survival, recurrence, or disease-free survival. Conclusions: N+ at the origin of the SMA was not a significant prognostic factor for PDA and should no longer be considered as a formal contraindication for curative surgery. Conversely, N2 invasion remains an unfavorable prognostic.