# Positive Lymph Nodes Independently Affect Long-Term Survival After Pancreaticoduodenectomy for Non-Ampullary Duodenal Adenocarcinoma: A Single-Center, Retrospective Analysis

## TL;DR

This study finds that lymph node involvement significantly affects survival in patients with non-ampullary duodenal adenocarcinoma after surgery.

## Contribution

The study identifies lymph node stations 8 and 12 as critical for survival and suggests a minimum number of lymph nodes to examine for accurate staging.

## Key findings

- Positive lymph nodes are linked to worse survival outcomes in non-ampullary duodenal adenocarcinoma patients.
- Lymph node ratio, tumor grade, and metastases at stations 8 and 12 independently predict overall survival.
- A minimum of 25 examined lymph nodes is recommended to detect metastases with 95% probability.

## Abstract

Background/Objectives: The main treatment for non-ampullary duodenal adenocarcinoma (NDA) is pancreatoduodenectomy (PD) with lymphadenectomy (LN). Several studies have proposed a minimum number of examined lymph nodes (MNELN) to ensure proper staging. This study investigated the impact of nodal parameters—including the pattern of nodal spread—on oncologic outcomes following PD for NDA. Furthermore, we sought to determine the MNELN to ensure reliable detection of nodal involvement. Methods: This was a single-center, retrospective study. Consecutive patients who underwent PD from 2000 to 2019 with a final diagnosis of NDA were retrieved from a prospectively maintained database. The probability of detecting at least one metastatic LN in a node-positive patient was assessed using a model based on the binomial probability law. Results: A total of 70 patients met the inclusion criteria. The median number of ELNs was 35 (22–43, IQR). Thirty-six patients (51%) had at least one PLN. A node-positive disease was associated with adverse pathologic features, including high tumor grade and perineural and peripancreatic fat invasion. This translated into a greater recurrence rate (p < 0.001). The MNELN yielding a 95% probability of detecting at least one metastatic node in a node-positive patient was 25. After a median follow-up of 73 months, the median recurrence-free survival (RFS) was 33 months (95% CI 13–97), and the overall survival (OS) was 41 months (95% CI 17–96). The LN ratio, tumor grade, and metastases at stations 8 and 12 were independently associated with OS (p < 0.05). Conclusions: Nodal metastases are common among patients with NDA and have a considerable impact on long-term survival. Stations 8 and 12 were associated with OS. Therefore, an adequate lymphadenectomy, possibly including stations 8 and 12, is recommended in patients with NDA.