title: Lymph nodes and survival in pancreatic neuroendocrine tumors.
abstract: OBJECTIVE
  Lymph node metastases decrease survival in patients with pancreatic neuroendocrine tumors (pNETs).
  
  
  METHODS
  Prospective database searches.
  
  
  METHODS
  National Institutes of Health (NIH) and Stanford University Hospital (SUH).
  
  
  METHODS
  A total of 326 patients underwent surgical exploration for pNETs at the NIH (n = 216) and SUH (n = 110).
  
  
  METHODS
  Overall survival, disease-related survival, and time to development of liver metastases.
  
  
  RESULTS
  Forty patients (12.3%) underwent enucleation and 305 (93.6%) underwent resection. Of the patients who underwent resection, 117 (35.9%) had partial pancreatectomy and 30 (9.2%) had a Whipple procedure. Forty-one patients also had liver resections, 21 had wedge resections, and 20 had lobectomies. Mean follow-up was 8.1 years (range, 0.3-28.6 years). The 10-year overall survival for patients with no metastases or lymph node metastases only was similar at 80%. As expected, patients with liver metastases had a significantly decreased 10-year survival of 30% (P < .001). The time to development of liver metastases was significantly reduced for patients with lymph node metastases alone compared with those with none (P < .001). For the NIH cohort with longer follow-up, disease-related survival was significantly different for those patients with no metastases, lymph node metastases alone, and liver metastases (P < .001). Extent of lymph node involvement in this subgroup showed that disease-related survival decreased as a function of the number of lymph nodes involved (P = .004).
  
  
  CONCLUSIONS
  As expected, liver metastases decrease survival of patients with pNETs. Patients with lymph node metastases alone have a shorter time to the development of liver metastases that is dependent on the number of lymph nodes involved. With sufficient long-term follow-up, lymph node metastases decrease disease-related survival. Careful evaluation of number and extent of lymph node involvement is warranted in all surgical procedures for pNETs.
authors.affiliation: Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305-5655, USA.
authors.forename: Geoffrey W
authors.initials: GW
authors.lastname: Krampitz
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Norton
authors.forename: George A
authors.initials: GA
authors.lastname: Poultsides
authors.forename: Brendan C
authors.initials: BC
authors.lastname: Visser
authors.forename: Lixian
authors.initials: L
authors.lastname: Sun
authors.forename: Robert T
authors.initials: RT
authors.lastname: Jensen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000401:mortality* / Q000556:secondary*; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology*; D011446:Prospective Studies; D015996:Survival Rate; D055815:Young Adult