Risk factors for lymph node metastasis in patients with pancreatic neuroendocrine neoplasms

Abstract

Background: Although PNENs generally have a better prognosis than pancreatic cancers, some PNENs display malignant behavior including lymph node (LN) metastasis. Complete tumor resection can be the only potentially curative treatment for patients with resectable PNENs. However, the indications for LN dissection are still controversial. Over the last decade, minimally invasive surgery such as laparoscopic pancreatic surgery (LPS) has been increasingly performed for pancreatic tumors including PNENs.

Aim: To investigate the risk factors for LN metastasis in PNENs and to select appropriate patients for limited surgery by LPS.

Methods: From April 2001 to December 2019, 92 patients underwent pancreatic resection for PNENs at Kumamoto University Hospital. Finally, 82 patients were enrolled in this study. Using perioperative factors, we examined the predictive factors for LN metastasis in PNENs.

Results: Among the 82 patients, the percentage of LN metastasis according to the pathological findings was 12% (10/82 cases). The median tumor size was 12 mm (range: 5-90 mm). The median tumor size in the LN-positive group (37 mm) was significantly larger than that in the LN-negative group (12 mm) (P = 0.0001). Multivariate analyses revealed that larger tumor size (≥ 20 mm) was an independent risk factor for LN metastasis (odds ratio 16.8, P = 0.0062). In patients with small tumors (≤ 10 mm), LN metastasis was not found.

Conclusion: Larger tumor size (≥ 20 mm) is an independent risk factor for LN metastasis in PNENs. In smaller PNENs (≤ 10 mm), we may be able to choose limited surgery without LN dissection.

Keywords: Lymph node metastasis; Pancreatic neuroendocrine neoplasms; Risk factor; Tumor size.

Figure 1

Rate of lymph node metastasis according to tumor size. The rates of lymph node metastasis according to tumor size were as follows: 0% (0/29 cases, ≤ 10 mm group), 3% (1/31 cases, 11 mm-20 mm group), 25% (2/8 cases, 21-30 mm group), 50% (3/6 cases, 31-40 mm group), and 50% (4/8 cases, > 40 mm group). LN: Lymph node.

Figure 2

Overall survival after surgery of 82 patients according to the presence of lymph node metastasis. The cumulative overall survival rate after surgery among patients who had no lymph node (LN) metastasis was significantly higher than that for those who had LN metastasis. LN: Lymph node.