Héloïse Seux, Jonathan Garnier, Jacques Ewald, Ugo Marchese, Flora Poizat, Jean-Robert Delpero, Olivier Turrini
Background The status of the para-aortic lymph node in pancreaticoduodenectomy patients has been thoroughly reported concerning pancreatic ductal adenocarcinoma, but not for other malignancies. The present study evaluated para-aortic lymph node status and its impact on eligible pancreaticoduodenectomy patients with distal cholangiocarcinoma. Methods From 2011 to 2019, all patients in our center who underwent pancreaticoduodenectomy were prospectively analyzed. In patients with suspected distal cholangiocarcinoma or pancreatic ductal adenocarcinoma, a frozen para-aortic lymph node section was routinely created. Sections reported as negative were immunohistochemically analyzed for micro-metastases. This study included all distal cholangiocarcinoma tumor specimens (not pancreatic ductal adenocarcinoma), as confirmed by an experienced pathologist. Results Forty-two patients underwent pancreaticoduodenectomy for distal cholangiocarcinoma. The median number of para-aortic lymph node analyzed was 2 (range 1-7) out of a median number of 15 lymph nodes. The R1 resection rate was 19%. All Para-aortic lymph node section analyses were negative, as were the definitive pathology results; overall median survival was 59 months. Conclusion Para-aortic lymph nodes are a rare site of lymphatic spread in patients with distal cholangiocarcinoma. Although our small sample size precludes definitive conclusions, it highlights the debate about lymphatic drainage in distal cholangiocarcinoma.
