Role of Lymph Node Resection and Histopathological Evaluation in Accurate Staging of Nonfunctional Pancreatic Neuroendocrine Tumors: How Many Are Enough?

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

Research output: Contribution to journalArticle


Background: Nodal involvement has been identified as one of the strongest prognostic factors in patients with nonfunctional pancreatic neuroendocrine tumors (NF-PanNETs). Sufficient lymphadenectomy and evaluation is vital for accurate staging. The purpose of this study was to identify the optimal number of examined lymph nodes (ELN) required for accurate staging. Methods: The SEER database was used to identify patients with resected NF-PanNETs between 2004 and 2014. The distributions of positive lymph nodes (PLN) ratio and total lymph nodes were used to develop a mathematical model. The sensitivity of detecting nodal disease at each cutoff of ELN was estimated and used to identify the optimal cutoff for ELN. Results: A total of 1098 patients were included in the study of which 391 patients (35.6%) had nodal disease. The median ELN was 12 (interquartile range [IQR]: 7–19.5), and the median PLN was 2 (IQR: 1–4) for patients with nodal disease. With an increase in ELN, the sensitivity of detecting nodal disease increased from 12.0% (ELN: 1) to 92.2% (ELN: 20), plateauing at 20 ELN (< 1% increase in sensitivity with an additional ELN). This sensitivity increase pattern was similar in subgroup analyses with different T stages. Conclusions: The sensitivity of detecting nodal disease in patients with NF-PanNETs increases with an increase in the number of ELN. Cutoffs for adequate nodal assessment were defined for all T stages. Utilization of these cutoffs in clinical settings will help with patient prognostication and management.

Original languageEnglish (US)
JournalJournal of Gastrointestinal Surgery
StateAccepted/In press - Jan 1 2020



  • Endocrine disease
  • Lymph node excision
  • Neoplasm staging
  • Neuroendocrine tumors
  • Pancreatectomy

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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