Ding-Hui Dong1, Xu-Feng Zhang1,2, George Poultsides3, Flavio Rocha4, Sharon Weber5, Ryan Fields6, Kamran Idrees7, Cliff Cho8, Shishir K Maithel9, Timothy M Pawlik2. 1. Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China. 2. Division of Surgical Oncology, Wexner Medical Center and James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio. 3. Department of Surgery, Stanford University, Palo Alto, California. 4. Department of Surgery, Virginia Mason Medical Center, Seattle, Washington. 5. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. 6. Department of Surgery, Washington University School of Medicine, St. Louis, Missouri. 7. Division of Surgical Oncology, Department of Surgery, Vanderbilt University, Nashville, Tennessee. 8. Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan. 9. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Abstract
BACKGROUND: The current study sought to define the impact of lymph node metastasis (LNM) relative to tumor size on tumor recurrence after curative resection for nonfunctional pancreatic neuroendocrine tumors (NF-pNETs) ≤2 cm. METHODS: Patients who underwent curative resection for ≤2-cm NF-pNETs were identified from a multi-institutional database. Risk factors associated with tumor recurrence as well as LNM were identified. Recurrence-free survival (RFS) was compared among patients with or without LNM. RESULTS: A total of 392 ≤2-cm NF-pNETs patients were identified. Among the 328 patients who had lymph node dissection and evaluation, 42 (12.8%) patients had LNM. LNM was associated with tumor recurrence (hazard ratio, 3.06; P = .026) after surgery. RFS was worse among LNM vs no LNM patients (5-year RFS, 81.7% vs 94.1%; P = .019). Patients with tumors measuring 1.5-2 cm had a two-fold increase in the incidence of LNM vs patients with tumors <1.5 cm (17.9% vs 8.7%, odds ratio, 2.59; P = .022), as well as a higher risk of advanced tumor grade and higher Ki-67 levels (both P < .01). After curative resection, a total of 14 (8.0%) patients with a tumor of 1.5-2 cm and 10 (4.5%) patients with tumor <1.5 cm developed tumor recurrence. CONCLUSION: Surgical resection with lymphadenectomy should be considered for patients with NF-pNETs ≥1.5-2.0 cm.
BACKGROUND: The current study sought to define the impact of lymph node metastasis (LNM) relative to tumor size on tumor recurrence after curative resection for nonfunctional pancreatic neuroendocrine tumors (NF-pNETs) ≤2 cm. METHODS:Patients who underwent curative resection for ≤2-cm NF-pNETs were identified from a multi-institutional database. Risk factors associated with tumor recurrence as well as LNM were identified. Recurrence-free survival (RFS) was compared among patients with or without LNM. RESULTS: A total of 392 ≤2-cm NF-pNETs patients were identified. Among the 328 patients who had lymph node dissection and evaluation, 42 (12.8%) patients had LNM. LNM was associated with tumor recurrence (hazard ratio, 3.06; P = .026) after surgery. RFS was worse among LNM vs no LNM patients (5-year RFS, 81.7% vs 94.1%; P = .019). Patients with tumors measuring 1.5-2 cm had a two-fold increase in the incidence of LNM vs patients with tumors <1.5 cm (17.9% vs 8.7%, odds ratio, 2.59; P = .022), as well as a higher risk of advanced tumor grade and higher Ki-67 levels (both P < .01). After curative resection, a total of 14 (8.0%) patients with a tumor of 1.5-2 cm and 10 (4.5%) patients with tumor <1.5 cm developed tumor recurrence. CONCLUSION: Surgical resection with lymphadenectomy should be considered for patients with NF-pNETs ≥1.5-2.0 cm.
Authors: Elettra Merola; Andrea Michielan; Umberto Rozzanigo; Marco Erini; Sandro Sferrazza; Stefano Marcucci; Chiara Sartori; Chiara Trentin; Giovanni de Pretis; Franca Chierichetti Journal: World J Gastrointest Surg Date: 2022-02-27