title: Analysis of lymph node metastasis in pancreatic neuroendocrine tumors (PNETs) based on the tumor size and hormonal production.
abstract: BACKGROUND
  Because of the rarity and variety of pancreatic neuroendocrine tumors (PNETs), there have been few reports regarding the indication for lymph node dissection in patients with these tumors. This study aimed to evaluate the risk of lymph node metastasis of PNETs based on the tumor size and hormonal production.
  
  
  METHODS
  Data for a total of 66 patients who had PNETs resected at our department between 1987 and 2010 were retrospectively studied. The clinicopathological features, including the disease-specific survival rate, were assessed based on the status of lymph node metastasis at the time of initial surgical resection. Then the cut-off point of tumor size to predict lymph node metastasis was estimated.
  
  
  RESULTS
  There were 12 patients (18%) with lymph node metastasis. The frequency of lymph node metastasis tended to be higher in gastrinomas than that in other tumors (43 vs. 15%; P = 0.08). The size of PNETs with lymph node metastasis was significantly larger than that of the PNETs without metastasis (P = 0.04). The postoperative survival rate in the PNET patients with lymph node metastasis was significantly lower than that in the patients without metastasis (P < 0.0001). Only 2 (8%) of 26 PNETs with a tumor size of <15 mm had lymph node metastasis, and both of these were gastrinomas. On the other hand, 10 (25%) of the remaining 40 PNETs with a tumor size of ≥15 mm had lymph node metastasis. Notably, there were no PNETs with lymph node metastasis in 22 non-gastrinomas with a tumor size of <15 mm.
  
  
  CONCLUSIONS
  Non-gastrinomas with a tumor size of ≥15 mm and all gastrinomas would be an indication for pancreatectomy with lymph node dissection.
authors.affiliation: Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka, 812-8582, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Tsutsumi
authors.forename: Takao
authors.initials: T
authors.lastname: Ohtsuka
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Mori
authors.forename: Minoru
authors.initials: M
authors.lastname: Fujino
authors.forename: Takaharu
authors.initials: T
authors.lastname: Yasui
authors.forename: Shinichi
authors.initials: S
authors.lastname: Aishima
authors.forename: Shunichi
authors.initials: S
authors.lastname: Takahata
authors.forename: Masafumi
authors.initials: M
authors.lastname: Nakamura
authors.forename: Tetsuhide
authors.initials: T
authors.lastname: Ito
authors.forename: Masao
authors.initials: M
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D015408:Gastrinoma / Q000378:metabolism / Q000473:pathology / Q000556:secondary / Q000601:surgery; D006728:Hormones / Q000096:biosynthesis; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000378:metabolism / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D006728:Hormones