ORIGINAL ARTICLE—LIVER, PANCREAS, AND BILIARY TRACT Postoperative prognosis of pancreatic cancer with para-aortic lymph node metastasis: a multicenter study on 822 patients Masayuki Sho • Yoshiaki Murakami • Fuyuhiko Motoi • Sohei Satoi • Ippei Matsumoto • Manabu Kawai • Goro Honda • Kenichiro Uemura • Hiroaki Yanagimoto • Masanao Kurata • Takumi Fukumoto • Takahiro Akahori • Shoichi Kinoshita • Minako Nagai • Satoshi Nishiwada • Michiaki Unno • Hiroki Yamaue • Yoshiyuki Nakajima Received: 5 September 2014 / Accepted: 28 September 2014 Ó Springer Japan 2014 Abstract Background The prognosis of pancreatic cancer patients with metastatic para-aortic lymph node (PALN) has been reported to be extremely poor. In general, PALN metastasis has been considered as a contraindication for pancreatic resection. The aim of this study was to reevaluate the post- operative prognostic value of PALN metastasis in pancreatic cancer and to determine the validity of pancreatic surgery. Methods Retrospective multicenter analysis of 882 patients who have undergone curative-intent pancreatic resection with pathological evaluation of PALNs for pan- creatic ductal adenocarcinoma between 2001 and 2012 was conducted. Clinicopathological data and outcomes were evaluated with univariate and multivariate analysis. Results In total, 102 (12.4 %) patients had positive metastasis in PALN. Patients with metastatic PALN had significantly poorer survival than those without (17 vs. 23 months; p \ 0.001). Multivariable analysis of 822 patients identified adjuvant chemotherapy, primary tumor status, regional lymph node metastasis, portal vein inva- sion, pre- and post-operative serum CA19-9 levels, and tumor grade as independent prognostic factors. In contrast, PALN metastasis did not have a significant prognostic value. Furthermore, the multivariate prognostic analysis in patients with PALN metastasis revealed that adjuvant chemotherapy and the number of metastatic PALN were significantly associated with long-term survival. Lung metastasis as initial recurrence was observed more often in patients with PALN metastasis in comparison with those without. Conclusions Some pancreatic cancer patients with meta- static PALN may survive for longer than expected after pancreatectomy. Adjuvant chemotherapy and the number of metastatic PALN were critical factors for long-term survival of those patients. Keywords Pancreatic cancer Á Para-aortic lymph node metastasis Á Postoperative prognosis M. Sho (&) Á T. Akahori Á S. Kinoshita Á M. Nagai Á S. Nishiwada Á Y. Nakajima Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan e-mail: m-sho@naramed-u.ac.jp Y. Murakami Á K. Uemura Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan F. Motoi Á M. Unno Division of Gastroenterological Surgery, Department of Surgery, Tohoku University, Sendai, Japan S. Satoi Á H. Yanagimoto Department of Surgery, Kansai Medical University, Osaka, Japan I. Matsumoto Á T. Fukumoto Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan M. Kawai Á H. Yamaue Second Department of Surgery, Wakayama Medical University, Wakayama, Japan G. Honda Á M. Kurata Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan 123 J Gastroenterol DOI 10.1007/s00535-014-1005-4