What question did this study set out to answer?

The aim is to analyze how the location of ductal adenocarcinoma affects lymph node metastasis and overall survival.

June 20, 2026Cancers0 citationsOpen Access

Analysis of the Distribution of Lymph Node Metastases and Their Impact on the Prognosis in Ductal Adenocarcinoma of the Distal Part of the Pancreas—A Single-Center Retrospective Study

MGMagdalena GajdaMedical University of Silesia EGEwa GrudzińskaMedical University of Silesia SMSławomir MrowiecMedical University of Silesia

Key Points

The aim is to analyze how the location of ductal adenocarcinoma affects lymph node metastasis and overall survival.
Retrospective analysis of 163 patients undergoing radical distal pancreatectomy with splenectomy and lymphadenectomy.
Patients categorized by tumor location: neck (PN), body (PB), and tail (PT).
Statistical analyses focused on the correlation between lymph node metastasis and overall survival.
Tumors in the pancreatic tail had a high nodal metastasis rate to group 10 (84.4%; p < 0.001).
Tumors in the pancreatic body showed a significant association with group 11 (72.7%; p = 0.004).
Higher grading and specific lymph node involvement significantly influenced overall survival (HRs with p < 0.001).

Abstract

Background: Lymphadenectomy is an important element of the surgical treatment of pancreatic ductal adenocarcinoma (PDAC). The study aimed to analyze the distribution of lymph node metastases in three nodal stations—group 10 (splenic hilum), group 11 (along the splenic artery), and group 18 (inferior pancreatic margin) depending on the location of PDAC in the distal pancreas: pancreatic neck (PN) vs. pancreatic body (PB) vs. pancreatic tail (PT). Methods: Data from 163 patients who underwent radical (R0) distal pancreatectomy with splenectomy (DP-S) with standard lymphadenectomy (removal of lymph nodes in groups 10, 11, and 18) for PDAC between 2010 and 2023 were analyzed. Patients were assigned to three groups based on the location of the primary tumor: neck (PN, n = 52), body (PB, n = 66), and tail (PT, n = 45). Results: The pattern of nodal metastasis was found to be dependent on the location of PDAC: group 10 (p < 0.001) is characteristic for tumor location in the PT (84.4%; 95% CI: 70–93%) and group 11 (p = 0.004) for tumors located in the PB (72.7%; 95% CI: 60–83%). Lymphatic drainage in group 18 constitutes a common zone, involved regardless of PDAC location (p = 0.185). In multivariate analysis, independent factors influencing overall survival were grading (HR 4.74; 95% CI 2.93–7.68; p < 0.001), lymph node metastasis in group 10 (HR = 3.65; 95% CI: 2.34–5.70; p < 0.001), group 11 (HR = 4.42; CI: 2.56–7.63; p < 0.001), group 18 (HR = 3.26; CI: 1.93–5.51; p < 0.001), and the use of neoadjuvant chemotherapy (HR = 0.57; CI: 0.39–0.84; p = 0.005). Conclusions: PDAC location in the distal pancreas influences metastasis to specific lymph node locations. Metastases to regional lymph node stations are associated with survival after DP-S procedures. In our retrospective cohort, neoadjuvant chemotherapy is associated with a lower risk of death and distant metastases due to PDAC after DP-S procedures.

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