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 journalArticlepeer-review

Abstract

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)
Pages (from-to)428-435
Number of pages8
JournalJournal of Gastrointestinal Surgery
Volume25
Issue number2
DOIs
StatePublished - Feb 2021

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Fingerprint

Dive into the research topics of 'Role of Lymph Node Resection and Histopathological Evaluation in Accurate Staging of Nonfunctional Pancreatic Neuroendocrine Tumors: How Many Are Enough?'. Together they form a unique fingerprint.

Cite this