Pancreatic neuroendocrine tumors: Preoperative factors that predict lymph node metastases to guide operative strategy

Abstract

For pancreatic neuroendocrine tumors, male gender, head/uncinate location, and size ≥2 cm are associated with nodal-metastases. Nodal involvement is associated with decreased recurrence-free survival. Anatomic resection may be preferred in patients with these characteristics, as enucleation alone may under-stage patients and does not appear to be associated with an improved complication profile. J. Surg. Oncol. 2016;114:440-445. © 2016 Wiley Periodicals, Inc.

Association of preoperative monocyte‐to‐lymphocyte and neutrophil‐to‐lymphocyte ratio with recurrence‐free and overall survival after resection of pancreatic neuroendocrine tumors (US‐NETSG)

“…The best cutoff in our study was on the basis of the prediction of RFS and OS in our study whereas in other studies, it was on the basis of lymph nodes or prediction of recurrence . Tumor size, which has been reported to be associated with lymph node positivity in PNETS was found to be a significant predictor of both RFS and OS in both univariate and multivariate analysis in our data set. Therefore, in addition to tumor size and symptoms at the time of diagnosis, circulating neutrophil, and lymphocyte numbers are essential drivers in the establishment of lymph node metastasis and systemic metastasis and can be used as biomarkers.…”

Duodenal neuroendocrine tumors: Somewhere between the pancreas and small bowel?

“…Several clinicopathologic variables including tumor size and margin status have been found to be predictors of survival . However, the prognostic importance of nodal metastasis has remained controversial in several recent population‐based studies . As a result, while early ENETS recommendations defined surgery as the only acceptable option for P‐NETs, most recent guidelines recommend watchful observation in selected patients who might not benefit from immediate intervention .…”

“…As a result, while early ENETS recommendations defined surgery as the only acceptable option for P‐NETs, most recent guidelines recommend watchful observation in selected patients who might not benefit from immediate intervention . Despite a 6% to 10% risk of nodal metastasis reported in most surgical series, updated ENETS guidelines suggest that observation is reasonable for small, <2 cm tumors due to their excellent long‐term survival particularly when considering the known morbidity of pancreatic surgery . Conversely, given their established propensity for distant metastasis, an oncologic resection is recommended for P‐NETs ≥ 2 cm and operative approach spans enucleation with formal lymphadenectomy to anatomic resection (AR) including pancreaticoduodenectomy or distal pancreatectomy …”

“…[7][8][9][10][11][12] However, the prognostic importance of nodal metastasis has remained controversial in several recent population-based studies. [13][14][15][16][17][18] As a result, while early ENETS recommendations defined surgery as the only acceptable option for P-NETs, most recent guidelines recommend watchful observation in selected patients who might not benefit from immediate intervention. 4 Despite a 6% to 10% risk of nodal metastasis reported in most surgical series, updated ENETS guidelines suggest that observation is reasonable for small, <2 cm tumors due to their excellent long-term survival particularly when considering the known morbidity of pancreatic surgery.…”

“…4 Despite a 6% to 10% risk of nodal metastasis reported in most surgical series, updated ENETS guidelines suggest that observation is reasonable for small, <2 cm tumors due to their excellent long-term survival particularly when considering the known morbidity of pancreatic surgery. 4,[18][19][20][21] Conversely, given their established propensity for distant metastasis, an oncologic resection is recommended for P-NETs ≥ 2 cm and operative approach spans enucleation with formal lymphadenectomy to anatomic resection (AR) including pancreaticoduodenectomy or distal pancreatectomy. 4 In contrast to P-NETs, significant predictors of survival for small bowel neuroendocrine tumors (SB-NETs) include lymph node and distant metastasis for all tumor size categories.…”