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Resection of At-Risk Mesenteric Lymph Nodes Is Associated with Improved Survival in Patients with Small Bowel Neuroendocrine Tumors

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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.

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Acknowledgments

This study was supported by the Khalifa Bin Zayed Al Nahyan Foundation, various donors to the Pancreatic Research Fund at MD Anderson Cancer Center, and the National Institutes of Health through MD Anderson’s Cancer Center Support Grant CA016672.

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Authors and Affiliations

  1. Department of Surgical Oncology, Baylor University Medical Center, 3410 Worth Street, Suite 235, Dallas, TX, 75246, USA

    Christine S. Landry

  2. Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

    Heather Y. Lin

  3. Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

    Alexandria Phan & James C. Yao

  4. Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

    Chusilp Charnsangavej

  5. Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, 1400 Pressler Street, FCT17.5048, Houston, TX, 77030, USA

    Eddie K. Abdalla, Thomas Aloia, J. Nicolas Vauthey, Matthew H. G. Katz & Jason B. Fleming

Authors
  1. Christine S. Landry
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  2. Heather Y. Lin
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  3. Alexandria Phan
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  4. Chusilp Charnsangavej
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  5. Eddie K. Abdalla
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  6. Thomas Aloia
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  7. J. Nicolas Vauthey
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  8. Matthew H. G. Katz
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  9. James C. Yao
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  10. Jason B. Fleming
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Corresponding authors

Correspondence to Christine S. Landry or Jason B. Fleming.

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Landry, C.S., Lin, H.Y., Phan, A. et al. Resection of At-Risk Mesenteric Lymph Nodes Is Associated with Improved Survival in Patients with Small Bowel Neuroendocrine Tumors. World J Surg 37, 1695–1700 (2013). https://doi.org/10.1007/s00268-013-1918-8

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  • DOI: https://doi.org/10.1007/s00268-013-1918-8

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