Copyright
©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Risk factors for lymph node metastasis in patients with pancreatic neuroendocrine neoplasms
Yosuke Nakao, Hiromitsu Hayashi, Yo-ichi Yamashita, Ofuchi Takashi, Kazuki Matsumura, Norio Uemura, Fumimasa Kitamura, Rumi Itoyama, Toshihiko Yusa, Katsunobu Taki, Tatsunori Miyata, Takaaki Higashi, Shigeki Nakagawa, Hirohisa Okabe, Katsunori Imai, Hideo Baba
Yosuke Nakao, Hiromitsu Hayashi, Yo-ichi Yamashita, Ofuchi Takashi, Kazuki Matsumura, Norio Uemura, Fumimasa Kitamura, Rumi Itoyama, Toshihiko Yusa, Katsunobu Taki, Tatsunori Miyata, Takaaki Higashi, Shigeki Nakagawa, Hirohisa Okabe, Katsunori Imai, Hideo Baba, Department of Gastroenterological Surgery, Kumamoto University, Kumamoto 860-8556, Japan
Author contributions: Nakao Y, Hayashi H and Yamashita Y designed the research study; Nakao Y, Takashi O, Matsumura K, Uemura N, Kitamura F, Itoyama R, Yusa T, Taki K, Miyata T, Higashi T, Nakagawa S, Okabe H and Imai K performed the research; Yamashita Y and Baba H contributed new reagents and analytic tools; Nakao Y, Hayashi H and Takashi O analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.
Institutional review board statement: Institutional Review Board of Kumamoto University (number 1291).
Informed consent statement: Consent was obtained from the patient and family according to Institutional Review Board protocols.
Conflict-of-interest statement: All the authors have no conflicts of interest in association with this study. No financial support was received for the work described in this manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Hiromitsu Hayashi, FACS, MD, PhD, Surgeon, Department of Gastroenterological Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan. hhayasi@kumamoto-u.ac.jp
Received: April 10, 2021
Peer-review started: April 10, 2021
First decision: July 6, 2021
Revised: October 24, 2021
Accepted: May 21, 2022
Article in press: May 21, 2022
Published online: June 24, 2022
BACKGROUND
Although PNENs generally have a better prognosis than pancreatic cancers, some PNENs display malignant behavior including lymph node (LN) metastasis. Complete tumor resection can be the only potentially curative treatment for patients with resectable PNENs. However, the indications for LN dissection are still controversial. Over the last decade, minimally invasive surgery such as laparoscopic pancreatic surgery (LPS) has been increasingly performed for pancreatic tumors including PNENs.
AIM
To investigate the risk factors for LN metastasis in PNENs and to select appropriate patients for limited surgery by LPS.
METHODS
From April 2001 to December 2019, 92 patients underwent pancreatic resection for PNENs at Kumamoto University Hospital. Finally, 82 patients were enrolled in this study. Using perioperative factors, we examined the predictive factors for LN metastasis in PNENs.
RESULTS
Among the 82 patients, the percentage of LN metastasis according to the pathological findings was 12% (10/82 cases). The median tumor size was 12 mm (range: 5-90 mm). The median tumor size in the LN-positive group (37 mm) was significantly larger than that in the LN-negative group (12 mm) (P = 0.0001). Multivariate analyses revealed that larger tumor size (≥ 20 mm) was an independent risk factor for LN metastasis (odds ratio 16.8, P = 0.0062). In patients with small tumors (≤ 10 mm), LN metastasis was not found.
CONCLUSION
Larger tumor size (≥ 20 mm) is an independent risk factor for LN metastasis in PNENs. In smaller PNENs (≤ 10 mm), we may be able to choose limited surgery without LN dissection.
Core Tip: Among the 82 patients, the percentage with lymph node (LN) metastasis according to the pathological findings was 12% (10/82 cases). The median tumor size was 12 mm (range: 5-90 mm). The median tumor size in the LN-positive group (37 mm) was significantly larger than that in the LN-negative group (12 mm) (P = 0.0001). Multivariate analyses revealed that large tumor size (≥ 20 mm) was an independent risk factor for LN metastasis. In patients with small tumors (≤ 10 mm), LN metastasis was not found. In conclusion, large tumor size (≥ 20 mm) is an independent risk factor for LN metastasis in PNENs. In smaller PNENs (≤ 10 mm), we may be able to choose limited surgery without LN dissection.
