RT Journal
A1 Krampitz GW, Norton JA, Poultsides GA, Visser BC, Sun L, Jensen RT
T1 LYmph nodes and survival in pancreatic neuroendocrine tumors
JF Archives of Surgery
JO Archives of Surgery
YR 2012
FD September 1
VO 147
IS 9
SP 820
OP 827
DO 10.1001/archsurg.2012.1261
UL http://dx.doi.org/10.1001/archsurg.2012.1261
AB Hypothesis 
                  Lymph node metastases decrease survival in patients with pancreatic neuroendocrine tumors (pNETs).Design 
                  Prospective database searches.Setting 
                  National Institutes of Health (NIH) and Stanford University Hospital (SUH).Patients 
                  A total of 326 patients underwent surgical exploration for pNETs at the NIH (n = 216) and SUH (n = 110).Main Outcome Measures 
                  Overall survival, disease-related survival, and time to development of liver metastases.Results 
                  Forty patients (12.3%) underwent enucleation and 305 (93.6%) underwent resection. Of the patients who underwent resection, 117 (35.9%) had partial pancreatectomy and 30 (9.2%) had a Whipple procedure. Forty-one patients also had liver resections, 21 had wedge resections, and 20 had lobectomies. Mean follow-up was 8.1 years (range, 0.3-28.6 years). The 10-year overall survival for patients with no metastases or lymph node metastases only was similar at 80%. As expected, patients with liver metastases had a significantly decreased 10-year survival of 30% (P < .001). The time to development of liver metastases was significantly reduced for patients with lymph node metastases alone compared with those with none (P < .001). For the NIH cohort with longer follow-up, disease-related survival was significantly different for those patients with no metastases, lymph node metastases alone, and liver metastases (P < .001). Extent of lymph node involvement in this subgroup showed that disease-related survival decreased as a function of the number of lymph nodes involved (P = .004).Conclusions 
                  As expected, liver metastases decrease survival of patients with pNETs. Patients with lymph node metastases alone have a shorter time to the development of liver metastases that is dependent on the number of lymph nodes involved. With sufficient long-term follow-up, lymph node metastases decrease disease-related survival. Careful evaluation of number and extent of lymph node involvement is warranted in all surgical procedures for pNETs.