Pancreatic neuroendocrine tumors: Preoperative factors that predict lymph node metastases to guide operative strategy

Background Enucleation and anatomic resection (central, distal, or pancreaticoduodenectomy) are surgical options for pancreatic neuroendocrine tumors. Depending on nodal‐status, enucleation alone may not be oncologically appropriate. Preoperative factors predictive of nodal‐involvement are not well...

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Published in:Journal of surgical oncology 2016-09, Vol.114 (4), p.440-445
Main Authors: Postlewait, Lauren M., Ethun, Cecilia G., Baptiste, Gillian G., Le, Nina, McInnis, Mia R., Cardona, Kenneth, Russell, Maria C., Sarmiento, Juan M., Kooby, David A., Staley, Charles A., Maithel, Shishir K.
Format: Article
Language:English
Subjects:
Adult
Aged
Female
Humans
Lymph Node Excision
lymph node metastasis
lymphadenectomy
Lymphatic Metastasis
Male
Metastasis
Middle Aged
Neoplasm Recurrence, Local
Neuroendocrine Tumors - mortality
Neuroendocrine Tumors - pathology
Neuroendocrine Tumors - surgery
Pancreatic Neoplasms - mortality
Pancreatic Neoplasms - pathology
Pancreatic Neoplasms - surgery
pancreatic neuroendocrine tumors
recurrence
Retrospective Studies
Tumors
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Summary:Background Enucleation and anatomic resection (central, distal, or pancreaticoduodenectomy) are surgical options for pancreatic neuroendocrine tumors. Depending on nodal‐status, enucleation alone may not be oncologically appropriate. Preoperative factors predictive of nodal‐involvement are not well defined. Methods Patients who underwent curative‐intent enucleation or resection of non‐metastatic, well/moderately differentiated tumors at a single institution (2000–2014) were included. The aim was to determine factors associated with nodal‐metastases and recurrence‐free survival. Results Of 195 patients undergoing resection, 164 met inclusion‐criteria. Lymphadenectomy was performed in 131 (80%), and 32 (24%) had nodal‐metastases. Receiver‐operative‐characteristics analysis revealed tumor size ≥2 cm was associated with nodal‐involvement (AUC: 0.689; Sensitivity: 90%; Specificity: 53%). On multivariable analysis, male gender (OR: 3.16; 95%CI: 1.18–8.46; P = 0.02), head/uncinate location (HR: 5.37; 95%CI: 2.07–13.96; P = 0.001), and size ≥2 cm (HR: 6.52; 95%CI: 1.75–24.30; P = 0.005) were associated with nodal‐positivity. Nodal‐metastases (HR: 3.04; 95%CI: 1.04–8.91; P = 0.043) and advanced T‐stage (HR: 5.39; 95%CI: 1.46–19.95; P = 0.012) were independently associated with decreased recurrence‐free survival. Enucleation (n = 17; 10%) had more positive margins and similar complication rates, pancreatic fistula rates, and lengths of stay as anatomic resections. Conclusion For pancreatic neuroendocrine tumors, male gender, head/uncinate location, and size ≥2 cm are associated with nodal‐metastases. Nodal involvement is associated with decreased recurrence‐free survival. Anatomic resection may be preferred in patients with these characteristics, as enucleation alone may under‐stage patients and does not appear to be associated with an improved complication profile. J. Surg. Oncol. 2016;114:440–445. © 2016 Wiley Periodicals, Inc.
ISSN:0022-4790
1096-9098
DOI:10.1002/jso.24338