LAUSR

By systematically dissecting stations 6, 8a-p, 12a-b-p, 13, 14a-b, 17 as well as jejunal mesentery nodes in 424 patients undergoing upfront PD, this study prospectively investigated the nodal yields and the impact on staging and survival outcomes per anatomic location and nodal echelon. The proportion of node-positive patients was 88.2%. The overall median number of examined nodes was 42, and the median number of metastatic nodes was 4. The contribution of the first nodal echelon, defined as stations embedded with the PD specimen, was predominant (median of 28 examined nodes and 4 positive nodes). The second nodal echelon, defined as stations harvested as separate specimens, increased the median nodal count by 10 nodes. Modeling a staging process with or without the second echelon did not lead to substantial differences in nodal classification. The most common metastatic sites were in the first echelon (stations 13 [77.8 %] and 14 [57.5 %]). The aggregate rate of second-echelon metastases approached 30 %. Remarkably, only metastases to station 14 and jejunal mesentery nodes (which occur in nearly 10 % of patients) were prognostically relevant.