Pancreatic cancer resection: what's the optimal LN number?

  • J Am Coll Surg

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • To capture 90% of pancreatic cancer N1 cases, 18 lymph nodes (LNs) should be excised during resection.

Why this matters

  • There is debate about how many LNs should be removed during resection, and previous studies have suggested 11-17 LNs are sufficient.
  • The study uses the log odds of metastatic (positive) LN (LODDS), defined as the log of the ratio positive LN to negative LN, to evaluate lymphadenectomies. It gets around some of the limitations of other methods such as LN ratio or N0/N1.

Study design

  • Retrospective analysis of 24,038 pancreatic cancer resection records from the National Cancer Database (2010-2015).
  • Funding: None disclosed.

Key results

  • 33.9% had LN-negative disease; 66.1% were LN-positive (N1).
  • LODDS calculations showed that the lower 10% of N1 disease was −2.744, which translates to a target LN threshold of 18. To capture 95%, 24 LNs would need to be examined.
  • 27.8% of the N1 population had fewer than 1 in 10 positive LNs, and 12.4% had fewer than 1 in 17 positive LNs.

Limitations

  • Retrospective analysis.

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