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Introduction The aim of this study is to analyze the impact of hepatic artery lymph node (HALN) involvement on the survival of patients undergoing pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PA). Methods A single-center retrospective study analyzing patients who underwent PD for PA. Patients were included if, during PD, the HALN was submitted for pathologic evaluation. Patients were stratified by node status: PPLN− (peripancreatic lymph node)/HALN−, PPLN+/HALN− and PPLN+/HALN+. Survival analysis was estimated by the Kaplan–Meier method, and Cox regression was used for risk factors analyses. Results Out of the 118 patients who underwent PD for PA, HALN status was analyzed in 64 patients. The median follow-up was 20 months (r: 1–159 months). HALN and PPLN were negative in 12 patients (PPLN−/HALN−, 19%), PPLN was positive and HALN negative in 40 patients (PPLN+/HALN−, 62%), PPLN and HALN were positive in 12 patients (PPLN+/HALN+, 19%) and PPLN was negative and HALN positive in 0 patients (PPLN−/HALN+, 0%). The overall 1, 3 and 5-year survival rates were statistically better in the PPLN−/HALN− group (82%, 72%, 54%) than in the PPLN+/HALN− group (68%, 29%, 21%) and the PPLN+/HALN+ group (72%, 9%, 9%, respectively) (P=.001 vs P=.007). The 1, 3 and 5-year probabilities of cumulative recurrence were also statistically better in the PPLN−/HALN− group (18%, 46%, 55%) than in the PPLN+/HALN− group (57%, 80%, 89%) and the PPLN+/HALN+ group (46%, 91%, 100%, respectively) (P=.006 vs P=.021). In the multivariate model, the main risk factor for overall survival and recurrence was lymphatic invasion, regardless of HALN status. Conclusions In pancreatic adenocarcinoma patients with lymph node disease, survival after PD is comparable regardless of HALN status.

Introduction The benefit of pancreaticoduodenectomy (PD) with superior mesenteric-portal vein resection (PVR) for pancreatic adenocarcinoma (PA) is still controversial in terms of morbidity, mortality and survival. We conducted a retrospective study to analyse outcomes of PD with PVR in a Spanish tertiary centre. Methods Between 2002 and 2012, 10 patients underwent PVR (PVR+ group) and 68 standard PD (PVR− group). Morbidity, mortality, overall survival (OS) and disease-free survival (DFS) were compared between PVR+ and PVR− group. Prognostic factors were identified by a Cox regression model. Results Postoperative mortality was 5% (4/78), all patients in PVR− group. Morbidity was higher in the PVR− group compared to PVR+ (63% vs 30%, P=.004). OS at 3 and 5 years was 43% and 43% in PVR+ group, 35% and 29% in PVR− group (P=.07). DFS at 3 and 5 years DFS were 28% and 15% in PVR+ group, 25% and 20% in PVR− group (P=.84). Median survival was 23.1 months in PVR− group, and 22.8 months in PVR+ group (P=.73). Factors related with OS were absence of adjuvant treatment (OR 2.9, 95%IC: 1.39–6.14, P=.003), R1 resection (OR 2.3, 95%IC: 1.2–4.43, P=.006), preoperative CA 19.9 level ≥ 170 UI/mL (OR 2.3, 95%IC: 1.22–4.32, P=.01). DFS risk factors were R1 resection (OR 2.6, 95%IC: 1.41–4.95, P=.002); moderate or poor tumour differentiation grade (OR 2.7, 95%IC: 1.23–6.17, P=.01); N1 lymph node status (OR 1.8, 95%IC: 1.02–3.19, P=.04); CA 19.9 level ≥ 170 UI/mL (OR 2.4, 95%IC: 1.30–4.54, P=.005). Conclusions PVR for PA can be performed safely. Patients with PVR have a comparable survival to patients undergoing standard PD if disease-free margins can be obtained.