LAUSR

The decision to perform a pancreatoduodenectomy for suspected periampullary cancer depends on vascular involvement, distant metastases, and lymph node metastases. Lymph node involvement of the paraaortic lymph node (PALN; station 16) corresponds with distant metastases according to the Japanese Pancreas Society Classification of Pancreatic Cancer but not in the current edition of the AJCC Cancer Staging Manual. Also, the International Study Group on Pancreatic Surgery does not include PALN in standard lymphadenectomy for pancreatoduodenectomy. Poor survival after pancreatoduodenectomy with positive PALN has been seen previously, but its prognostic significance has not been established. Some studies have identified patients who might benefit from resection, while others routinely perform a palliative bypass procedurewhenpositive PALNs are foundduring exploration. The optimal strategy to approach PALN during surgery remains unclear.