{
  "abstract": "IntroductionThe optimal examined lymph node (ELN) count after resection for pancreatic body/tail ductal adenocarcinoma (PDAC) is debated. We combined SEER-based survival modelling with a hypothesis-generating theoretical framework to identify ELN thresholds and how surgical approach influences attainability.\n\nMethodSEER (2000-2022) resected pancreatic body/tail PDAC cases were analysed (n=5 107). Thresholds were identified by log-rank grid search and segmented Cox changepoint analysis; multivariable Cox and overlap- and inverse-probability-weighted restricted mean survival time (RMST) analyses were performed.\n\nResultsAmong 5 107 patients, ELN=12 was the optimal cut-point and ELN=21 the changepoint (95% CI 6.0-35.0). Each 5-node increase in ELN was associated with HR 0.964 (95% CI 0.949-0.980); overlap-weighted 60-month RMST gain for ELN>=21 was 2.60 months (95% CI 1.30-3.90). Distribution-derived (model-estimated) ELN>=21 attainment was 16.5% (DP), 40.0% (RAMPS), and 82.7% (n=9, deep retroperitoneal/left-posterior). Theoretical modeling estimated model ELN of 16, 21, and 27 for DP, RAMPS, and Mattox, with Monte Carlo P(ELN>=21) of 5.5%, 34.8%, and 92.9%. Quality-weighted risk reduction was 22.9% for Mattox versus 8.4% for RAMPS.\n\nConclusionELN>=12 is a minimum quality benchmark, and approximately 21 a potential higher-yield target. Standard DP carries an accessibility gap for the higher target. Theoretical modeling suggests the Mattox maneuver could bridge this gap, but this remains hypothesis-generating and requires prospective validation.",
  "abstract_shown": true,
  "affiliations": [
    "Department of General Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China."
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "name": "X. Ye"
    },
    {
      "name": "Y. Wang"
    },
    {
      "name": "W. Yang"
    },
    {
      "name": "J. Wu"
    },
    {
      "name": "J. Fang"
    },
    {
      "name": "G. M. Kihaga"
    },
    {
      "affs": [
        0
      ],
      "name": "Y. Zheng"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/6e0agg922av8w.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.07.06.26357392",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.07.06.26357392v4.full",
  "id": "6e0agg922av8w",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.07.06.26357392v4",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "oncology"
    ],
    [
      "openalex",
      "2730|Pancreatic and Hepatic Oncology Research"
    ]
  ],
  "openalex": "W7167796127",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.07.06.26357392v4.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-07-06",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/6e0agg922av8w.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:25Z",
      "native_id": "10.64898/2026.07.06.26357392",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.07.06.26357392v4"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:oncology",
      "subfield": "oncology"
    }
  ],
  "title": "Deep Fascia Plane Dissection and Mattox Maneuver for Lymphadenectomy in Pancreatic Body-Tail Cancer: SEER-Based Evidence, Anatomical Rationale, and Quantitative Modeling",
  "title_text": "Deep Fascia Plane Dissection and Mattox Maneuver for Lymphadenectomy in Pancreatic Body-Tail Cancer: SEER-Based Evidence, Anatomical Rationale, and Quantitative Modeling",
  "type": "preprint",
  "updated_at": "2026-10-30T12:17:25Z",
  "url": "https://research.draconitic.com/paper/6e0agg922av8w",
  "venue": "medRxiv",
  "versions": []
}