ASO Author Reflections: Lymph Node Metastasis and the Role for Lymphadenectomy During Surgery for Nonfunctional Pancreatic Neuroendocrine Tumors

Excerpt

Nonfunctional pancreatic neuroendocrine tumors (PanNETs) are a heterogeneous group of tumors that represent a small but increasing proportion of pancreatic neoplasms.1,2 Given the behavioral variability of these tumors, oncology teams have struggled to predict individual disease courses.3 As such, a reliance on other disease factors, such as lymph node spread, is important to anticipate disease progression. Among nonfunctional PanNETs specifically, the association between positive lymph nodes and poor outcomes has been clearly established.4 Since nodal metastases may serve as a surrogate for worse disease, various studies have focused on the ability to predict nodal positivity with other preoperatively available tumor factors.3,4 Despite the known utility of lymph node evaluation, the number of nodes needed for accurate staging at resection has not been defined. Thus, the aim of our study was (1) to determine preoperative factors associated with nodal metastases among resected nonfunctional PanNETs, and (2) to establish a procedure-specific threshold for the number of lymph nodes needed for accurate staging.5 …