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

Ding, Ding; Javed, Ammar A.; Yuan, Chunhui; Wright, Michael J.; Javed, Zunaira; Teinor, Jonathan A.; Ye, I. Chae; Burkhart, Richard A.; Cameron, John L.; Weiss, Matthew J.; Wolfgang, Christopher L.; He, Jin

doi:10.1007/s11605-020-04521-w

Cited by 9 publications

(5 citation statements)

References 27 publications

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“…In pancreatic neuroendocrine neoplasms (pNEN), the association between the surgical access [1,2], the extent of resection [3][4][5], simultaneous lymphadenectomy [6] and the patient's oncological outcome is a subject of discussion. However, severe postoperative complications are frequent and occur in 15.6% of the patients after surgery for gastroentero-pancreatic neuroendocrine neoplasm (NEN) [7].…”

Section: Introductionmentioning

confidence: 99%

Resection of Non-Functional Pancreatic Neuroendocrine Neoplasms—A Single-Center Retrospective Outcome Analysis

et al. 2021

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Surgery remains the only curative treatment of pancreatic neuroendocrine neoplasms (pNEN). Here, we report the outcome after surgery for non-functional pNEN at a European Neuroendocrine Tumor Society (ENETS) center in Germany between 2000 and 2019; cases were analyzed for surgical (Clavien–Dindo classification; CDc) and oncological outcomes. Forty-nine patients (tumor grading G1 n = 25, G2 n = 22, G3 n = 2), with a median age of 56 years, were included. Severe complications (CDc ≥ grade 3b) occurred in 11 patients (22.4%) and type B/C pancreatic fistulas (POPFs) occurred in 5 patients (10.2%); in-hospital mortality was 2% (n = 1). Six of seven patients with tumor recurrence (14.3%) had G2 tumors in the pancreatic body/tail. The median survival was 5.7 years (68 months; [1–228 months]). Neither the occurrence (p = 0.683) nor the severity of complications had an influence on the relapse behavior (p = 0.086). This also applied for a POPF (≥B, p = 0.609). G2 pNEN patients (n = 22) with and without tumor recurrence had similar median tumor sizes (4 cm and 3.9 cm, respectively). Five of the six relapsed G2 patients (83.3%) had tumor-positive lymph nodes (N+); all G2 pNEN patients with recurrence had initially been treated with distal pancreatic resection. Pancreatic resections for pNEN are safe but associated with relevant postoperative morbidity. Future studies are needed to evaluate suitable resection strategies for G2 pNEN.

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Section: Introductionmentioning

confidence: 99%

Resection of Non-Functional Pancreatic Neuroendocrine Neoplasms—A Single-Center Retrospective Outcome Analysis

et al. 2021

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“…In the 8th edition of the tumor, node, metastasis (TNM) staging manual by the American Joint Committee on Cancer (AJCC), the number of removed LNs is still not clearly defined, and the new N staging cannot distinguish between the prognoses of different patients. Some studies found that the percentage and number of positive LNs (PLNs) could be used as indicators of survival prediction, 9,14,15 but this is still controversial. The total numbers of removed LNs and negative LNs (NLNs) can reflect the degree of LND in surgery and are independent prognostic factors in gastric cancer, 16 rectal cancer, 9 breast cancer, 17 lung cancer, 18 and others.…”

Section: Introductionmentioning

confidence: 99%

Role of Removed Lymph Nodes on the Prognosis of M0 Small-Bowel Neuroendocrine Tumors: a Propensity Score Matching Analysis from SEER Database

Xie

Pang

et al. 2021

Journal of Gastrointestinal Surgery

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Background Current studies on the number of removed lymph nodes (LNs) and their prognostic value in small-bowel neuroendocrine tumors (SBNETs) are limited. This study aimed to clarify the prognostic value of removed LNs for SBNETs. Methods SBNET patients without distant metastasis from 2004 to 2017 in the SEER database were included. The optimal cutoff values of examined LNs (ELNs) and negative LNs (NLNs) were calculated by the X-tile software. Propensity score matching (PSM) was done to match patients 1:1 on clinicopathological characteristics between the two groups. The Kaplan-Meier method with log-rank test and multivariable Cox proportional-hazards regression model were used to evaluate the prognostic effect of removed LNs. Results The cutoff values of 14 for ELNs and 9 for NLNs could well distinguish patients with different prognoses. After 1:1 PSM, the differences in clinicopathological characteristics between the two groups were significantly reduced (all P > 0.05). Removal of more than one LN significantly improved the prognosis of the patients (P < 0.001). The number of lymphatic metastasis in the sufficiently radical resection group (SRR, 3.74 ± 3.278, ELN > 14 and NLN > 9) was significantly more than that in the insufficiently radical resection group (ISRR, 2.72 ± 3.19, ELN < 14 or NLN < 9). The 10-year overall survival (OS) of the SRR was significantly better than that of the ISRR (HR = 1.65, P = 0.001, 95% CI: 1.24–2.19). Conclusion Both ELNs and NLNs can well predict the OS of patients. Systematic removal of more than 14 LNs and more than 9 NLNs can increase the OS of SBNET patients.

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“…However, the accuracy of preoperative assessment of nodal staging is still a matter of debate. The presence of nodal metastases (N+), that occur in 30% to 50% of patients who undergo surgery, is one of the most powerful predictors of recurrence after surgery for NF-PanNETs 12–18. It is then of paramount importance to predict the risk of N+ to plan an adequate lymphadenectomy avoiding atypical resections [ie, enucleation, central pancreatectomy, or regulated distal pancreatectomy (DP)] that affect the number of harvested lymph nodes (LNs) 19,20.…”

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confidence: 99%

“…The presence of nodal metastases (N+), that occur in 30% to 50% of patients who undergo surgery, is one of the most powerful predictors of recurrence after surgery for NF-PanNETs. [12][13][14][15][16][17][18] It is then of paramount importance to predict the risk of N+ to plan an adequate lymphadenectomy avoiding atypical resections [ie, enucleation, central pancreatectomy, or regulated distal pancreatectomy (DP)] that affect the number of harvested lymph nodes (LNs). 19,20 Prior reports have found that tumor size larger than 2 cm, a pancreatic head localization, a high tumor grade, and the presence of suspicious N+ at imaging, are associated with an increased risk of N+.…”

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confidence: 99%

A Single-center Prospective Observational Study Investigating the Accuracy of Preoperative Diagnostic Procedures in the Assessment of Lymph Node Metastases in Nonfunctioning Pancreatic Neuroendocrine Tumors

et al. 2022

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To determine the accuracy of preoperative imaging, including contrast-enhanced computed tomography (CE-CT), endoscopic ultrasound (EUS), and 68 Gallium-DOTATOC positron emission tomography ( 68 Ga-DOTATOC PET), in identifying nodal metastases (N+) in sporadic nonfunctioning pancreatic neuroendocrine tumors (NF-PanNETs). Background: An accurate preoperative identification of N+ in NF-PanNETs is critical for surgical planning. The accuracy of different imaging techniques in detecting lymph node (LN) metastases in NF-PanNETs has been poorly investigated. Methods: All consecutive patients undergoing surgery for sporadic NF-PanNETs (2018 were enrolled in a prospective study (DETECTYON; NCT03918759). The accuracy of preoperative imaging techniques in detecting N+ was assessed through sensitivity, specificity positive and negative predictive values. Results: Overall, 100 patients with NF-PanNETs underwent CE-CT, EUS, and 68 Ga-DOTATOC PET before pancreatic resection. LN metastases were found in 42 cases (42%). Sensitivity, specificity, positive predictive value, and negative predictive value of different imaging techniques were 26%, 95%, 79%, 64% for CE-CT, 19%, 98%, 89%, 63% for EUS, and 12%, 95%, 63%, 60% for 68 Ga-DOTATOC PET, respectively. Radiologic tumor size > 4 cm and the presence of radiologic N+ at ≥ 1 imaging were independent predictors of N+ at pathology. The identification of N+ at ≥ 1 imaging technique was associated with a higher number of positive LNs compared with negative imaging (4 vs 2) (P = 0.012). Conclusions: CE-CT, EUS, and 68 Ga-DOTATOC PET are poorly sensitive in predicting nodal status in NF-PanNETs despite a high specificity.

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

Cited by 9 publications

References 27 publications

Resection of Non-Functional Pancreatic Neuroendocrine Neoplasms—A Single-Center Retrospective Outcome Analysis

Resection of Non-Functional Pancreatic Neuroendocrine Neoplasms—A Single-Center Retrospective Outcome Analysis

Role of Removed Lymph Nodes on the Prognosis of M0 Small-Bowel Neuroendocrine Tumors: a Propensity Score Matching Analysis from SEER Database

A Single-center Prospective Observational Study Investigating the Accuracy of Preoperative Diagnostic Procedures in the Assessment of Lymph Node Metastases in Nonfunctioning Pancreatic Neuroendocrine Tumors

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