Lymph node yield significantly impacts overall survival and time to recurrence in node-negative pancreatic ductal adenocarcinoma after neoadjuvant therapy.

• Lymph node yield of 22 or more nodes correlates with a median survival of 59 months compared to 25 months for fewer nodes (p < 0.001).
• In a large cohort, those with lymph node yield ≥ 22 experienced prolonged time to recurrence (32 months vs. 14 months, p = 0.019).

Surgeons should aim for optimal lymph node sampling to enhance surgical outcomes and guide patient selection.

• Lymph node yield was an independent predictor of survival in both Massachusetts General Hospital and National Cancer Database cohorts.