Nonfunctional pancreatic neuroendocrine tumors: how many lymph nodes for staging?

  • Lopez-Aguiar AG & al.
  • Ann Surg Oncol
  • 19 Apr 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Pancreatoduodenectomy (PD) inherently removes enough lymph nodes (LN) to accurately stage nonfunctional pancreatic neuroendocrine tumors (PanNETs), but distal pancreatectomy (DP) may need to be accompanied by splenectomy to achieve sufficient LN removal.

Why this matters

  • The study is the first to determine the procedure-specific LN number needed to accurately stage PanNETs.

Study design

  • Retrospective analysis of 695 patients undergoing curative-intent resection of low- to intermediate-grade, nonfunctional PanNETs at 8 institutions.
  • Funding: Katz Foundation; NIH.

Key results

  • A multivariate analysis showed that factors associated with LN positivity were tumor size ≥2 cm (OR, 4.9; P<.001 proximal tumor location p=".008)," and ki-67>
  • There was no significant difference in recurrence-free survival (RFS) between node-positive and node-negative patients when the number of LNs removed was
  • Among patients who underwent DP, the median number of LNs retrieved was 9, and the median was 4 among those who did not undergo concomitant splenectomy (P<.001 those with ln metastases had a rfs of in without>
  • No threshold for LN removal was determinable in PD procedures, likely because the procedures inherently removed enough LNs to accurately stage PanNETs.

Limitations

  • Retrospective analysis.