title: Resection of at-risk mesenteric lymph nodes is associated with improved survival in patients with small bowel neuroendocrine tumors.
abstract: BACKGROUND
  Neuroendocrine tumors of the small intestine commonly metastasize to regional lymph nodes (LNs). Single-institution reports suggest that removal of LNs improves outcome, but comprehensive data are lacking. We hypothesized that the extent of lymphadenectomy reported in a large administrative database would be associated with overall survival for jejunal and ileal neuroendocrine tumors.
  
  
  METHODS
  A search of the Surveillance Epidemiology and End Results database was performed for patients with jejunal and ileal neuroendocrine tumors from 1977 to 2004. Descriptive patient characteristics were collected to include age at diagnosis, sex, race, grade, primary tumor size, LN status, number of LNs resected, presence of distant metastasis, and the type of operation. Statistical analyses were limited to patients with only one primary tumor to exclude patients with other malignancies. Univariate and multivariate analyses were performed to analyze the number of LNs resected and the LN ratio (number of positive LNs/total number of LNs removed) to determine the effect on cancer-specific survival.
  
  
  RESULTS
  Altogether, 1,364 patients were included in this analysis. Removal of any LNs was associated with improved cancer-specific survival when compared to patients with no LN removal reported (p = 0.0027) on univariate analysis. Among those who had any LNs removed, a median of eight LNs were identified in resection specimens with a median LN ratio of 0.29 (range 0-1). On multivariate analysis (adjusting for age and tumor size), patients with >7 LNs removed experienced better cancer-specific survival than those with ≤ 7 LNs removed (median survival not reached vs. 140 months): hazard ratio and 95 % confidence interval were 0.573 (0.402, 0.817) (p = 0.002).
  
  
  CONCLUSIONS
  This review of a large number of surgical patients demonstrates that regional mesenteric lymphadenectomy in conjunction with resection of the primary tumor is associated with improved survival of patients with small bowel neuroendocrine tumors.
authors: Department of Surgical Oncology, Baylor University Medical Center, 3410 Worth Street, Suite 235, Dallas, TX 75246, USA. Christine.Landry@Baylorhealth.edu
authors: Christine S
authors: CS
authors: Landry
authors: Heather Y
authors: HY
authors: Lin
authors: Alexandria
authors: A
authors: Phan
authors: Chusilp
authors: C
authors: Charnsangavej
authors: Eddie K
authors: EK
authors: Abdalla
authors: Thomas
authors: T
authors: Aloia
authors: J
authors: J
authors: Nicolas Vauthey
authors: Matthew H G
authors: MH
authors: Katz
authors: James C
authors: JC
authors: Yao
authors: Jason B
authors: JB
authors: Fleming
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007078:Ileal Neoplasms / Q000401:mortality / Q000601:surgery*; D007580:Jejunal Neoplasms / Q000401:mortality / Q000601:surgery*; D008197:Lymph Node Excision; D008297:Male; D008643:Mesentery; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D018426:SEER Program; D016019:Survival Analysis; D016896:Treatment Outcome
references: Ann Surg. 1974 Nov;180(5):720-7
references: 4421375
references: J Clin Oncol. 2008 Jun 20;26(18):3063-72
references: 18565894
references: Best Pract Res Clin Gastroenterol. 2005 Oct;19(5):717-28
references: 16253896
references: Ann Surg. 2009 Jan;249(1):63-71
references: 19106677
references: J Clin Oncol. 2008 Sep 10;26(26):4311-8
references: 18779618
references: Lancet. 2011 Dec 10;378(9808):2005-2012
references: 22119496
references: Cancer. 1970 Sep;26(3):547-51
references: 5458261
references: World J Surg. 2002 Aug;26(8):991-7
references: 12016480
references: Br J Surg. 2011 Nov;98(11):1617-24
references: 21858790