Reassessing the role of lymph node dissection in pancreatic cancer surgery: Balancing oncologic control and immune function preservation

Lymph node dissection (lymphadenectomy) remains a critical component of pancreatic cancer surgery, contributing to accurate staging and guiding adjuvant therapy. The debate between standard and extended lymphadenectomy persists, with evidence showing no significant survival advantage of extended dissection over the standard approach. Extended lymphadenectomy, while increasing the number of lymph nodes retrieved, is associated with longer operative times, greater blood loss, and higher morbidity. More importantly, lymph nodes serve as critical immune hubs, and excessive removal may compromise systemic immune surveillance, which is vital in the context of emerging immunotherapies for pancreatic cancer. This minireview synthesizes the oncological and immunological perspectives on lymphadenectomy, advocating for a personalized approach to lymph node management in pancreatic cancer surgery, focusing on balancing oncologic outcomes with immune preservation.