Para-Aortic Lymph Node Metastasis in Pancreatic Cancer: The Dilemma of Whether to Continue Surgery

Lymph node status is a critical prognostic factor for patients with pancreatic head cancer [1, 2, 3, 4, 5]. Peripancreatic nodes are the first to be involved. The paraaortic lymph nodes are involved later, via the lymphatics network surrounding the posterior pancreatoduodenal, superior mesenteric and common hepatic arteries [1, 2, 3, 4, 5]. Para-aortic lymph node involvement is considered M1 in TNM and in the Japanese Pancreas Society Classification of Pancreatic Cancer [6]. The incidence of positive paraaortic lymph nodes in patients with pancreatic head cancer is not well defined but in published series it ranges from 11 to 26%, and is even higher when the tumor is located in the uncinate process [2, 3, 6, 7]. Patients with positive para-aortic lymph nodes have poorer survival, but the prognostic significance of the condition has not been clearly established in the literature [5, 7].