• Annals of surgery · Dec 2019

    Number of Examined Lymph Nodes and Nodal Status Assessment in Distal Pancreatectomy for Body/Tail Ductal Adenocarcinoma.

    • Giuseppe Malleo, Laura Maggino, Cristina R Ferrone, Giovanni Marchegiani, Mari Mino-Kenudson, Paola Capelli, Borislav Rusev, Keith D Lillemoe, Claudio Bassi, Fernàndez-Del Castillo Carlos C Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA., and Roberto Salvia.
    • Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy.
    • Ann. Surg. 2019 Dec 1; 270 (6): 1138-1146.

    ObjectiveFirst, to assess the impact of the number of examined lymph nodes (ELNs) on staging and survival after distal pancreatectomy (DP) for pancreatic adenocarcinoma (PDAC). Second, to identify the minimum number of ELNs (MNELNs) ensuring an accurate detection of nodal involvement. Third, to reappraise the role of lymph node (LN) parameters, including N-status and lymph node ratio (LNR).BackgroundIn contrast with pancreatoduodenectomy, information on LN staging and the MNELN required in DP is lacking.MethodsPatients undergoing DP for PDAC at 2 academic hospitals from 2000 through 2013 were retrospectively analyzed. The eighth edition of the American Joint Committee on Cancer staging system was used. The MNELN was estimated using the binomial probability law. Survival analyses were performed separately for node-negative and node-positive patients using univariable and multivariable models.ResultsThe study population consisted of 240 patients. The median number of ELN was 21, significantly lower in node-negative patients as compared with node-positive patients (18.5 vs 24.0; P = 0.001). The proportion of node-positive patients increased with increasing numbers of ELNs, whereas LNR showed an inverse trend. The estimated MNELN was 20. The number of ELN (≥ or <20) was an independent prognostic factor only in node-negative patients [odds ratio (OR) 3.23 for ELN <20), suggesting a stage migration effect. In node-positive patients, N2-class, but not LNR, was a significant predictor of survival at multivariable analysis (OR 1.68).ConclusionThe number of ELN affects nodal staging in body/tail PDAC. At least 20 LNs are required for correct staging. N-status is superior to LNR in predicting survival of node-positive patients.

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