Lymphatic metastasis in pancreatic cancer: from bedside to bench and back

Pancreatic cancer is an extremely aggressive and lethal malignant cancer; almost half of the patients have distant metastasis when first diagnosed, and many challenges arise during treatment. Lymph node metastasis is a vital indicator of disease progression in pancreatic cancer and directly influences patient prognosis and survival rate. The cancer cells invade the lymphatics, promote the growth of lymphatics, propagate to lymph nodes, and finally settle down in lymph nodes. Aiming at this process, treatment modalities involving surgery, targeted therapy, and nanodelivery of chemotherapy are tested regarding their efficacy in both local tumor management and lymph node metastasis. As lymph node metastasis presents a poor prognosis and higher recurrence rate, precise assessment of lymph node metastasis is imperative for clinical management in pancreatic ductal adenocarcinoma. Precise evaluation of lymph node metastasis will not only help in formulating personalized treatment but also provide more accurate prognostic information to the patients. This review aims at synthesizing current knowledge of the molecular mechanisms, treatment options, clinical implications, and evaluation techniques regarding lymph node metastasis in pancreatic cancer, hence allowing a focused perspective for clinicians and researchers in striving for more effective management strategies against lymph node metastasis of pancreatic cancer.