Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 23.
doi: 10.1245/s10434-025-18029-7. Online ahead of print.

Optimal Number of Lymph Nodes Retrieved to Lower the Risk of False N0 for Patients with Pancreatic Cancer Undergoing Curative Surgery

So Jeong Yoon #  1 , Seung Soo Hong #  2 , Boram Park  3 , Sung Hyun Kim  2 , Chang Moo Kang  2 , Kyung Sik Kim  2 , Sang Hyun Shin  1 , In Woong Han  1 , Jin Seok Heo  1 , Ho Kyoung Hwang  4 , Hongbeom Kim #  5
Affiliations

Optimal Number of Lymph Nodes Retrieved to Lower the Risk of False N0 for Patients with Pancreatic Cancer Undergoing Curative Surgery

So Jeong Yoon et al. Ann Surg Oncol. .

Abstract

Background: Accurate LN examination is critical for staging and prognosis in pancreatic cancer. However, the ideal number of LNs required for precise staging and improved survival remains unclear. This study aimed to determine the optimal number of lymph nodes (LNs) to retrieve during pancreatectomy for pancreatic cancer to minimize false node-negative (false N0) rates and assess its impact on survival outcomes.

Methods: This retrospective cohort study analyzed data from patients undergoing curative-intent upfront surgery for pancreatic cancer at two tertiary centers in South Korea (2010-2021). An exploration cohort of 808 patients was used to identify LN retrieval thresholds, and the results were validated in an independent cohort of 444 patients. The study excluded patients who received neoadjuvant therapy or had fewer than two retrieved LNs. False N0 rates and 5 year overall survival were analyzed.

Results: In the exploration cohort, examining 16 LNs reduced the false N0 rate to 18.9%, whereas in the validation cohort, retrieving 12 LNs resulted in a false N0 rate of 19.5%. Among the node-negative (N0) patients, retrieving up to 21 LNs was associated with improved 5 year overall survival. Differences in cutoff values between cohorts were attributed to demographic variations and inclusion of fewer LNs retrieved but higher detection of metastatic nodes in the validation cohort.

Conclusions: Retrieving a sufficient number of LNs during pancreatectomy is essential to reducing false N0 rates and improving survival outcomes for pancreatic cancer patients. These findings highlight the need for standardized LN evaluation protocols and support further prospective, multi-center studies to optimize staging accuracy.

PubMed Disclaimer

Conflict of interest statement

Disclosure: There are no conflicts of interest.

References

    1. House MG, Gonen M, Jarnagin WR, et al. Prognostic significance of pathologic nodal status in patients with resected pancreatic cancer. J Gastrointest Surg. 2007;11:1549–55. https://doi.org/10.1007/s11605-007-0243-7 . - DOI - PubMed
    1. You MS, Lee SH, Choi YH, et al. Lymph node ratio as valuable predictor in pancreatic cancer treated with R0 resection and adjuvant treatment. BMC Cancer. 2019;19:952. https://doi.org/10.1186/s12885-019-6193-0 . - DOI - PubMed - PMC
    1. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Pancreatic Adenocarcinoma V.3.2024. Retrieved 1 December 1 2024 at https://www.nccn.org/Guidelines/Guidelines-Detail?Category=1&Id=1455 .
    1. Huang L, Jansen L, Balavarca Y, et al. Significance of examined lymph node number in accurate staging and long-term survival in resected stage I-II pancreatic cancer–more is better? A large international population-based cohort study. Ann Surg. 2021;274:e554–63. https://doi.org/10.1097/sla.0000000000003558 . - DOI - PubMed
    1. Huebner M, Kendrick M, Reid-Lombardo KM, et al. Number of lymph nodes evaluated: prognostic value in pancreatic adenocarcinoma. J Gastrointest Surg. 2012;16:920–6. https://doi.org/10.1007/s11605-012-1853-2 . - DOI - PubMed

LinkOut - more resources