Does lymph node ratio impact survival in resected periampullary malignancies?

Number of involved lymph nodes is important in the prediction of prognosis for primary duodenal adenocarcinoma

“…The total number of lymph nodes examined did not affect survival in our study (overall survival, p ¼ 0.296; disease-free survival, p ¼ 0.564) and in a small series reported by Struck et al 35 Nevertheless, several investigators proposed that an inadequate number of lymph nodes removed may impair prognostic discrimination due to inaccurate assessment of lymph node metastasis, which might understage cancer patients. 3,24,32 The correlation between survival and the number of total lymph node evaluated have also been shown in esophageal, gastric, pancreatic, and colorectal cancers. 11e13, 36 However, the exact number of lymph nodes that needed to be removed varied from study to study.…”

“…The cutoff value for each group was determined by previous studies. 3,17,18 The seventh edition of AJCC classification for malignant neoplasms of the small intestine was used for staging.…”

Extent of lymphadenectomy to associate with pancreaticoduodenectomy in patients with pancreatic head cancer for better tumor staging

“…The LN subgroups few (69), moderate (10-16), and large (P17) had mean LNR of 0.22, 0.14, and 0.13 respectively.'' The variety of TNLE reported by the different authors is also responsible for the apparent differences in the actual role of TPN, LNR, and LODDS in assessing a patient's prognosis [47,48,51,60,[85][86][87][88][89][90]. Large, prospectively collected data from cases undergoing a standard surgical procedure, and a standardized pathological examination, will bring to light the best method for assessing a patient's prognosis after resection of a cancer of the head of the pancreas.…”

“…àà Clusters of micrometastatic cells were identified in para-aortic nodes in 13.5% of patients, but they did not influence long term survival. TNLE (as previously reported), the total number of positive lymph nodes (TPN) [47,48,51,[85][86][87], the lymph node ratio (LNR) [47,48,51,60,86,[87][88][89], the log odds of positive lymph nodes (LODDS) [90]. It is easy to see that varying the number of resected lymph node stations at low risk of metastasis, and/or omitting one or more lymph node stations at significant risk of metastasis will negatively affect the accuracy of all these refined methods.…”

Pancreas sparing duodenectomy versus pancreaticodudoenectomy for duodenal carcinoma: a comparison study

“…32,33 Several previously published series compared the LNR of 0.2, 0.3 and 0.4 and found that greater the LNR, the worse the prognosis. 28,32 .…”