How many lymph nodes properly stage a periampullary malignancy?
The impact of lymphadenectomy in prognosis and staging in periampullary malignancies remains largely undefined. We examined all pancreaticoduodenectomies for periampullary carcinomas in the SEER cancer registry from 1993 through 2003. Overall, 5465 pancreaticoduodenectomies for nonmetastatic periampullary carcinomas were identified. The cohort was comprised of 62.5% pancreatic, 18.9% ampullary, 11.6% distal bile duct, and 7.0% duodenal cancers. A linear association between the number of lymph nodes (LNs) examined and overall survival was observed overall and for pancreas and ampullary cancers for node-negative (N0) disease. Median survival for all patients with localized, N0 disease improved from 24 to 31 months, with sampling of a minimum of 10 LNs, whereas 2 and 5-year survival improved from 52 and 29%, with <10 nodes examined to 58 and 37% with 10+ nodes examined (P<0.001). A 1-month median survival advantage was seen in patients with node-positive disease when more than 10 lymph nodes examined (15 versus 16 months, P<0.001). Significantly better median survival and cure rates are observed after pancreaticoduodenectomy for localized periampullary adenocarcinoma when a minimum of 10 lymph nodes are examined. This benefit likely represents more accurate staging. To optimize the prognostic accuracy and prevent stage migration errors in multicenter trials a minimum of 10 lymph nodes should be obtained and examined before the determination of node-negative disease.
Gutierrez
Juan C
JC
Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
Franceschi
Dido
D
Koniaris
Leonidas G
LG
D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000453:epidemiology / Q000556:secondary*; D017734:Bile Ducts, Extrahepatic; D004379:Duodenal Neoplasms / Q000453:epidemiology / Q000556:secondary*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000556:secondary*; D011379:Prognosis; D012189:Retrospective Studies; D018426:SEER Program / Q000706:statistics & numerical data; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
Arch Surg. 2003 Dec;138(12):1310-4; discussion 1315
14662530
Surg Gynecol Obstet. 1992 Sep;175(3):259-65
1514162
Ann Surg. 1998 Oct;228(4):508-17
9790340
J Am Coll Surg. 1998 Dec;187(6):597-603
9849732
Am J Clin Pathol. 1996 Aug;106(2):209-16
8712176
J Gastrointest Surg. 2006 May;10(5):689-97
16713541
Ann Surg. 2002 Sep;236(3):355-66; discussion 366-8
12192322
CA Cancer J Clin. 2000 Jul-Aug;50(4):241-68
10986966
Ann Surg. 1995 Jun;221(6):721-31; discussion 731-3
7794076
CA Cancer J Clin. 2006 Mar-Apr;56(2):106-30
16514137
Surgery. 1995 Jun;117(6):616-23
7778025
J Gastrointest Surg. 2000 Nov-Dec;4(6):567-79
11307091
Ann Surg Oncol. 2007 May;14(5):1712-7
17253102
J Clin Oncol. 2003 Aug 1;21(15):2912-9
12885809
Ann Surg Oncol. 1998 Mar;5(2):140-9
9527267
Surgery. 1973 Feb;73(2):307-20
4265314
Ann Surg. 2007 Feb;245(2):187-200
17245171
Br J Cancer. 2001 Jun 15;84(12):1602-9
11401312
Cancer. 1989 Sep 1;64(5):1132-7
2547508
Ann Surg Oncol. 2003 Jan-Feb;10(1):65-71
12513963
Ann Surg. 1998 Oct;228(4):449-61
9790335
Ann Surg Oncol. 2006 Nov;13(11):1485-92
17013688
Ann Surg Oncol. 2006 Sep;13(9):1189-200
16955385
Hepatogastroenterology. 1998 May-Jun;45(21):855-66
9684147
Ann Surg. 2003 Feb;237(2):163-7
12560772
J Clin Oncol. 2005 Oct 1;23(28):7114-24
16192595