Hawkins and colleagues at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, Missouri E-published an article on November 19, 2013 in the journal Annals of Surgery which examined regional lymph node status and the medical disposition of 136 of their patients who had received surgery for pancreatic neuroendocrine tumors from 1994 through 2012.
In this retrospective study the authors found that lymph node metastases were associated with bigger tumors. They also found increased regional lymph node presence in those tumors that were found in the head of the pancreas (not in the tail, for instance), those with high Ki-67 levels, and those with lymphatic vascular invasion. But perhaps the key finding was that at a p < 0.0001 level, the median survival was lower for those patients who evidenced lymph node metastases. The median survival duration for those without these metastases was 14.6 years versus 4.5 years for those with metastases.
The researchers conclude that these data suggest that regional lymphadenectomy may be an important additional step for patients with pancreatic neuroendocrine tumors who undergo pancreatic resection.
This research contains the inherent limitations of retrospective studies in general, and the primary conclusion (that lyphadenectomy may significantly prolong survival) does not necessarily strictly translate. Nevertheless, it is an interesting finding that may well be true. Thus, it is deserving of further inquiry – including perhaps a prospective study.
Dale O’Brien, MD