The Role of Non-Peripancreatic Lymph Nodes in the Survival of Patients Suffering from Pancreatic Cancer of the Body and Tail: A Systematic Review and Meta-Analysis of High-Quality Studies

SIMPLE SUMMARY: Lymph nodes metastases represent a well-known negative prognostic factor for patients suffering from pancreatic cancer of the body and tail. To date, international guidelines do not recommend an extended lymphadenectomy in left-sided pancreatic resections. However, the extent of the lymphadenectomy in these cases is still debated. The present study aimed to systematically review the current literature to explore the incidence and the prognostic impact of non-peripancreatic lymph nodes in patients suffering from pancreatic cancer of the body and tail. After the literature review, eight studies were included in the meta-analysis. An increased risk of death for patients with positive non-PLNs was detected (HR: 2.97; 95% CI: 1.81–4.91; p < 0.0001). Meta-analysis of the proportions highlighted different proportions of nodal infiltration according to nodal stations. A systematic extended lymphadenectomy, despite its potential beneficial prognostic effect, could not be recommended yet based on the results of the present study. ABSTRACT: Lymph nodes (LNs)’ metastases have a well-known detrimental impact on the survival outcomes of patients suffering from pancreatic cancer of the body and tail. However, the extent of the lymphadenectomy for this tumor location is still debated. The aim of this study was to systematically review the current literature to explore the incidence and the prognostic impact of non-peripancreatic lymph nodes (PLNs) in patients suffering from pancreatic cancer of the body and tail. A systematic review was conducted according to PRISMA and MOOSE guidelines. The primary endpoint was to assess the impact of non-PLNs on overall survival (OS). As a secondary endpoint, the pooled frequencies of different non-PLN stations’ metastatic patterns according to tumor location were explored. Eight studies were included in data synthesis. An increased risk of death for patients with positive non-PLNs was detected (HR: 2.97; 95% CI: 1.81–4.91; p < 0.0001). Meta-analysis of proportions pointed out a 7.1% pooled proportion of nodal infiltration in stations 8–9. The pooled frequency for station 12 metastasis was 4.8%. LN stations 14–15 were involved in 11.4% of cases, whereas station 16 represented a site of metastasis in 11.5% of cases. Despite its potential beneficial effect on survival outcome, a systematic extended lymphadenectomy could not be recommended yet for patients suffering from PDAC of the body/tail.