OBJECTIVES: Literature addressing the significance of lymph node positivity in the management of nonfunctional pancreatic neuroendocrine tumors (PNETs) is conflicting. METHODS: The National Cancer Data Base was queried for patients who underwent surgical resection of nonfunctional PNETs between 1998 and 2011. Clinical data and overall survival were analyzed using χ and Cox proportional hazards regression. Multiple imputation was used as a comparative analysis because of the high number of patients missing data on tumor grade. RESULTS: Two thousand seven hundred thirty-five patients were identified. The overall incidence of lymph node metastasis was 51%. In the subset of patients with grade 1 tumors less than 1 cm, 24% had positive lymph nodes. Overall median survival for patients with negative lymph nodes was 11 years compared with 8 years for lymph node-positive patients (P < 0.001). On multivariate survival analysis, tumor grade, distant metastases, regional lymph node involvement, positive surgical margins, male sex, and older age were predictive of decreased overall survival. CONCLUSIONS: Lymph node positivity was associated with decreased overall survival. The incidence of lymph node involvement in resected low-grade tumors less than 1 cm is higher than previously reported. Patients selected for resection of PNETs should be offered lymphadenectomy for staging.
OBJECTIVES: Literature addressing the significance of lymph node positivity in the management of nonfunctional pancreatic neuroendocrine tumors (PNETs) is conflicting. METHODS: The National Cancer Data Base was queried for patients who underwent surgical resection of nonfunctional PNETs between 1998 and 2011. Clinical data and overall survival were analyzed using χ and Cox proportional hazards regression. Multiple imputation was used as a comparative analysis because of the high number of patients missing data on tumor grade. RESULTS: Two thousand seven hundred thirty-five patients were identified. The overall incidence of lymph node metastasis was 51%. In the subset of patients with grade 1 tumors less than 1 cm, 24% had positive lymph nodes. Overall median survival for patients with negative lymph nodes was 11 years compared with 8 years for lymph node-positive patients (P < 0.001). On multivariate survival analysis, tumor grade, distant metastases, regional lymph node involvement, positive surgical margins, male sex, and older age were predictive of decreased overall survival. CONCLUSIONS: Lymph node positivity was associated with decreased overall survival. The incidence of lymph node involvement in resected low-grade tumors less than 1 cm is higher than previously reported. Patients selected for resection of PNETs should be offered lymphadenectomy for staging.
Authors: Ding Ding; Ammar A Javed; Chunhui Yuan; Michael J Wright; Zunaira N Javed; Jonathan A Teinor; I Chae Ye; Richard A Burkhart; John L Cameron; Matthew J Weiss; Christopher L Wolfgang; Jin He Journal: J Gastrointest Surg Date: 2020-02-05 Impact factor: 3.452
Authors: Kota Sahara; Diamantis I Tsilimigras; Rittal Mehta; Amika Moro; Anghela Z Paredes; Alexandra G Lopez-Aguiar; Flavio Rocha; Zaheer Kanji; Sharon Weber; Alexander Fisher; Ryan Fields; Bradley A Krasnick; Kamran Idrees; Paula M Smith; George A Poultsides; Eleftherios Makris; Cliff Cho; Megan Beems; Mary Dillhoff; Shishir K Maithel; Itaru Endo; Timothy M Pawlik Journal: Ann Surg Oncol Date: 2019-12-14 Impact factor: 5.344
Authors: Anna Nießen; Simon Schimmack; Marta Sandini; Dominik Fliegner; Ulf Hinz; Magdalena Lewosinska; Thilo Hackert; Markus W Büchler; Oliver Strobel Journal: Sci Rep Date: 2021-12-09 Impact factor: 4.379