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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2021

01-03-2021 | Metastasis | Pancreatic Tumors

Systematic Review and Metaanalysis of Lymph Node Metastases of Resected Pancreatic Neuroendocrine Tumors

Authors: Masayuki Tanaka, MD, PhD, Max Heckler, MD, André L. Mihaljevic, MD, Pascal Probst, MD, Ulla Klaiber, MD, Ulrike Heger, MD, Simon Schimmack, MD, Markus W. Büchler, MD, Thilo Hackert, MD

Published in: Annals of Surgical Oncology | Issue 3/2021

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Abstract

Background

The optimal surgical strategy for pancreatic neuroendocrine tumors (PNETs) is unknown. However, current guidelines recommend a watch-and-wait strategy for small nonfunctional PNETs (NF-PNETs). The aim of this study is to investigate the risk stratification and prognostic significance of lymph node metastasis (LNM) of PNETs to guide decision-making for lymphadenectomy.

Patients and Methods

The MEDLINE and Web of Science databases were systematically searched for studies reporting either risk factors of LNM in resected PNETs or survival of patients with LNM. The weighted average incidence of LNM was calculated according to tumor characteristics. Random-effects metaanalyses were performed, and pooled hazard ratios (HR) and their 95% confidence intervals (CI) were calculated to determine the impact of LNM on overall survival (OS). In subgroup analyses, NF-PNETs were assessed.

Results

From a total of 5883 articles, 98 retrospective studies with 13,374 patients undergoing resection for PNET were included. In all PNETs, the weighted median rates of LNM were 11.5% for small (≤ 2 cm) PNETs and 15.8% for G1 PNETs. In NF-PNETs, the rates were 11.2% for small PNETs and 10.3% for G1 PNETs. LNM of all PNETs (HR 3.87, 95% CI 3.00–4.99, P < 0.001) and NF-PNETs (HR 4.98, 95% CI 2.81–8.83, P < 0.001) was associated with worse OS.

Conclusions

LNM is potentially prevalent even in small and well-differentiated PNETs and is associated with worse prognosis. A watch-and-wait strategy for small NF-PNETs should be reappraised, and oncologic resection with lymphadenectomy can be considered. Prospective and controlled studies are needed in the future.
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Metadata
Title
Systematic Review and Metaanalysis of Lymph Node Metastases of Resected Pancreatic Neuroendocrine Tumors
Authors
Masayuki Tanaka, MD, PhD
Max Heckler, MD
André L. Mihaljevic, MD
Pascal Probst, MD
Ulla Klaiber, MD
Ulrike Heger, MD
Simon Schimmack, MD
Markus W. Büchler, MD
Thilo Hackert, MD
Publication date
01-03-2021
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 3/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-08850-7

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