Lu Wu1,2, Kota Sahara2,3, Diamantis I Tsilimigras2, Shishir K Maithel4, George A Poultsides5, Flavio G Rocha6, Sharon M Weber7, Ryan C Fields8, Kamran Idrees9, Clifford S Cho10, Feng Shen1, Timothy M Pawlik2. 1. Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China. 2. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio. 3. Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan. 4. Department of Surgery, Emory University, Atlanta, GA. 5. Department of Surgery, Stanford University, Stanford, CA. 6. Department of Surgery, Virginia Mason Medical Center, Seattle, Washington. 7. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. 8. Department of Surgery, Washington University School of Medicine, St. Louis, Missouri. 9. Division of Surgical Oncology, Department of Surgery, Vanderbilt University, Nashville, Tennessee. 10. Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
Abstract
BACKGROUND: The benefit derived from lymph node dissection (LND) in patients with pancreatic neuroendocrine tumors (pNETs) based on clinicopathological characteristics remains unclear. METHODS: Patients undergoing surgery for pNET between 1997 and 2016 were identified using a multi-institutional dataset. The therapeutic index of LND relative to patient characteristics was calculated. RESULTS: Among 647 patients, the median number of lymph nodes (LNs) evaluated was 10 (interquartile range: 4-16) and approximately one quarter of patients had lymph node metastasis (LNM) (N = 159, 24.6%). Among patients with LNM, 5-year recurrence-free survival was 56.0%, reflecting a therapeutic index value of 13.8. The therapeutic index was highest among patients with a moderately/poorly-differentiated pNET (21.5), Ki-67 ≥ 3% (20.1), tumor size ≥2.0 cm (20.0), and tumor location at the head of the pancreas (20.0). Patients with ≥8 LNs evaluated had a higher therapeutic index than patients who had 1 to 7 LNs evaluated (≥8: 17.9 vs 1-7: 7.5; difference of index: 11.4). CONCLUSION: LND was mostly beneficial among patients with pNETs >2 cm, Ki-67 ≥ 3%, and lesions located at the pancreatic head as identification of LNM was most common among individuals with these tumor characteristics. Evaluation of ≥8 LNs was associated with a higher likelihood of identifying LNM as well as a higher therapeutic index, and therefore this number of LNs should be considered the goal.
BACKGROUND: The benefit derived from lymph node dissection (LND) in patients with pancreatic neuroendocrine tumors (pNETs) based on clinicopathological characteristics remains unclear. METHODS:Patients undergoing surgery for pNET between 1997 and 2016 were identified using a multi-institutional dataset. The therapeutic index of LND relative to patient characteristics was calculated. RESULTS: Among 647 patients, the median number of lymph nodes (LNs) evaluated was 10 (interquartile range: 4-16) and approximately one quarter of patients had lymph node metastasis (LNM) (N = 159, 24.6%). Among patients with LNM, 5-year recurrence-free survival was 56.0%, reflecting a therapeutic index value of 13.8. The therapeutic index was highest among patients with a moderately/poorly-differentiated pNET (21.5), Ki-67 ≥ 3% (20.1), tumor size ≥2.0 cm (20.0), and tumor location at the head of the pancreas (20.0). Patients with ≥8 LNs evaluated had a higher therapeutic index than patients who had 1 to 7 LNs evaluated (≥8: 17.9 vs 1-7: 7.5; difference of index: 11.4). CONCLUSION: LND was mostly beneficial among patients with pNETs >2 cm, Ki-67 ≥ 3%, and lesions located at the pancreatic head as identification of LNM was most common among individuals with these tumor characteristics. Evaluation of ≥8 LNs was associated with a higher likelihood of identifying LNM as well as a higher therapeutic index, and therefore this number of LNs should be considered the goal.
Authors: Masayuki Tanaka; Max Heckler; André L Mihaljevic; Pascal Probst; Ulla Klaiber; Ulrike Heger; Simon Schimmack; Markus W Büchler; Thilo Hackert Journal: Ann Surg Oncol Date: 2020-07-27 Impact factor: 5.344
Authors: Kota Sahara; Diamantis I Tsilimigras; Shishir K Maithel; Daniel E Abbott; George A Poultsides; Ioannis Hatzaras; Ryan C Fields; Matthew Weiss; Charles Scoggins; Chelsea A Isom; Kamran Idrees; Perry Shen; Itaru Endo; Timothy M Pawlik Journal: J Surg Oncol Date: 2020-01-06 Impact factor: 2.885