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. 2022 May 10;22(1):160.
doi: 10.1186/s12893-022-01595-y.

Value of lymphadenectomy in patients with surgically resected pancreatic neuroendocrine tumors

Zheng Zhang #  1   2   3   4 , Fei Wang #  1   2   3   4 , Zheng Li #  1   2   3   4 , Zeng Ye  1   2   3   4 , Qifeng Zhuo  1   2   3   4 , Wenyan Xu  1   2   3   4 , Wensheng Liu  1   2   3   4 , Mengqi Liu  1   2   3   4 , Guixiong Fan  1   2   3   4 , Yi Qin  1   2   3   4 , Yue Zhang  5 , Xuemin Chen  5 , Xianjun Yu  6   7   8   9 , Xiaowu Xu  10   11   12   13 , Shunrong Ji  14   15   16   17
Affiliations

Value of lymphadenectomy in patients with surgically resected pancreatic neuroendocrine tumors

Zheng Zhang et al. BMC Surg. .

Abstract

Background: Although some factors that predict the prognosis in pancreatic neuroendocrine tumor (pNET) have been confirmed, the predictive value of lymph node metastasis (LNM) in the prognosis of pNETs remains conflicting and it is not clear whether regional lymphadenectomy should be performed in all grades of tumors.

Methods: We included pNET patients undergoing surgery in Shanghai pancreatic cancer institute (SHPCI). The risk factors for survival were investigated by the Kaplan-Meier method and Cox regression model. We evaluated the predictors of LNM using Logistic regression.

Results: For 206 patients in the SHPCI series, LNM was an independent prognostic factor for entire cohort suggested by multivariate Cox regression analysis. LNM (P = 0.002) predicted poorer overall survival (OS) in grade 2/3 cohort, but there is no significant association between LNM and OS in grade 1 cohort. Grade (P < 0.001) and size (P = 0.049) predicted LNM in entire cohort. Grade (P = 0.002) predicted LNM while regardless of size in grade 2/3 cohort.

Conclusions: Based on our own retrospective data obtained from a single center series, LNM seems to be associated with poorer outcome for patients with grade 2/3 and/or grade 1 > 4 cm tumors. On the other way, LNM was seems to be not associated with prognosis in patients with grade 1 tumors less than 4 cm. Moreover, tumor grade and tumor size seem to act as independent predictors of LNM. Thus, regional lymphadenectomy should be performed in grade 2/3 patients but was not mandatory in grade 1 tumors < 4 cm. It is reasonable to perform functional sparing surgery for grade 1 patients or propose a clinical-radiological monitoring.

Keywords: Lymph node metastasis; Lymphadenectomy; Pancreatic neuroendocrine tumors.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Overall survival for tumors of grade 1–3, grade 1 and grade 2/3 stratified by LNM from SHPCI (a log rank < 0.0001; b log rank > 0.9999; c log rank = 0.0003)
Fig. 2
Fig. 2
Overall survival for tumors of grade 1–3 stratified by LNM and LND from SHPCI (a log rank = 0.0004; b log rank = 0.6373; c log rank = 0.0011)
Fig. 3
Fig. 3
Overall survival for tumors of grade 1 and grade 2/3 stratified by LNM and LND from SHPCI (a log rank ≥ 0.9999; b log rank = 0.5753; c log rank = 0.9999; d 0.0047)
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