Background
Insufficient examination of lymph nodes after pancreaticoduodenectomy can lead some
pancreatic cancer patients with N1 disease to be misclassified as N0. We examined
trends in lymph node dissection throughout time and investigated how these changes
affect lymph node status and its prognostic value.
Methods
The National Cancer Data Base was queried for patients with nonmetastatic pancreatic
adenocarcinoma (2004–2013) who underwent classic pancreaticoduodenectomy with antrectomy.
Logistic regression was performed for odds of node positivity. Kaplan-Meier curves
and Cox proportional hazards models were used to assess the impact of lymph node status
on overall survival for patients diagnosed during 2-year intervals from 2004–2012.
Results
Median number of examined lymph nodes was 10 (interquartile range 6–15) in 2004 vs
17 (interquartile range 12–24) in 2013. Number of lymph nodes examined was a significant
predictor of N1 disease (P < .0001), with a plateau at 30 nodes. N1 disease increased from 64.4% to 68.0% (P < .0001). Survival for both N1 and N0 subgroups improved. In successive multivariate
models, N0 versus N1 status was consistently protective for overall survival (P < .0001), but there was no change in the magnitude of its hazard ratio over time
(overall hazard ratio 0.691; 95% confidence interval 0.660–0.723).
Conclusion
Contemporary patients have an adequate number of nodes examined during standard pancreaticoduodenectomy.
This, along with rising rates of N1 cancer detection and improved survival for both
node-positive and node-negative patients, suggest more accurate classification of
lymph node status. However, no increased benefit is achieved beyond 30 nodes. Overall,
lymph node status remains a strong prognosticator for overall survival.
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Article info
Publication history
Published online: November 16, 2016
Accepted:
September 24,
2016
Footnotes
Supported by the American Cancer Society MSRG 10-003-01 (to J.F.T.), a Howard Hughes Medical Institute Early Career Award, and an American Surgical Association Foundation Fellowship.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
