Pancreatic nodal metastases: biologic significance and therapeutic considerations

Adenocarcinoma of the pancreas remains a disease in which the majority of patients succumb to the neoplastic process, even after potentially curative resection. There has been an overall improvement in patient outcome in recent years, partially explicable by the increasing safety of pancreaticoduodenal resection. Factors that have been identified as being important in long-term survival include diploid tumor DNA content, small tumor size, absence of lymph node metastases, and resection with negative resection margins. Another factor that appears to favor long-term survival is the use of postoperative combined modality chemoradiation therapy. Clearly, newer treatment modalities should be evaluated in the hope of improving outcome. Additionally, developments in earlier detection and staging, via applications from the field of molecular genetics, may provide further improvements in outcome.