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A Novel Criterion for Lymph Nodes Dissection in Distal Pancreatectomy for Ductal Adenocarcinoma: A Population Study of the US SEER Database

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objective

The aim of this study was to clarify the minimum number of examined lymph nodes (MNELNs) required to ensure the quality of lymph node detection and its impact on long-term survival in distal pancreatectomy for pancreatic ductal adenocarcinoma.

Methods

Clinicopathological characteristics and survival data of patients with resectable pancreatic cancer who underwent distal pancreatectomy between 2004 and 2017 were collected from the Surveillance, Epidemiology, and End Results database. The associations between the number of examined lymph nodes (ELNs) and number of positive lymph nodes (PLNs), stage migration, and overall survival were investigated through adjusted multivariate models with locally weighted scatterplot smoothing smoothing fitting curves and estimation of the structural breakpoints. Kaplan–Meier survival analysis and X-tile software were used to identify the ideal cut-off value for ELNs.

Results

In total, 2610 consecutive patients who underwent distal pancreatectomy between 2004 and 2017 were included in this study. The optimal ELN count according to the associations between the number of ELNs and number of PLNs, odds ratio for stage migration, or hazard ratio for overall survival were 19, 17, and 19, respectively. Furthermore, the optimal division of ELN count for maximum overall survival was divided into three populations (ELN ≤ 8, ELN 9–18, ELN ≥ 19) based on X-tile software.

Conclusion

A minimal count of 19 lymph nodes was demanded to guarantee the quality of lymph node examination in patients with distal pancreatectomy. Long-term survival could be delimited by MNELNs. A sufficient number of ELNs could improve the accuracy of cancer staging and reflect a better overall survival.

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Funding

This study was supported by the Shanghai Medical Engineering and Collaborative Innovation Center (10-20-308-40).

Author information

Author notes

  1. Weishen Wang, Ziyun Shen, and Jun Zhang contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Weishen Wang M.D., Ziyun Shen M.D., Jun Zhang M.D., Hao Chen M.D., Xiaxing Deng M.D., Chenghong Peng M.D., Ph.D., Junjie Xie M.D., Zhiwei Xu M.D. & Baiyong Shen M.D., Ph.D.

  2. Research Institute of Pancreatic Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Weishen Wang M.D., Ziyun Shen M.D., Jun Zhang M.D., Hao Chen M.D., Xiaxing Deng M.D., Chenghong Peng M.D., Ph.D., Junjie Xie M.D., Zhiwei Xu M.D. & Baiyong Shen M.D., Ph.D.

  3. State Key Laboratory of Oncogenes and Related Genes, Shanghai, China

    Weishen Wang M.D., Ziyun Shen M.D., Jun Zhang M.D., Hao Chen M.D., Xiaxing Deng M.D., Chenghong Peng M.D., Ph.D., Junjie Xie M.D., Zhiwei Xu M.D. & Baiyong Shen M.D., Ph.D.

  4. Institute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, China

    Weishen Wang M.D., Ziyun Shen M.D., Jun Zhang M.D., Hao Chen M.D., Xiaxing Deng M.D., Chenghong Peng M.D., Ph.D., Junjie Xie M.D., Zhiwei Xu M.D. & Baiyong Shen M.D., Ph.D.

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  1. Weishen Wang M.D.
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  2. Ziyun Shen M.D.
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  7. Junjie Xie M.D.
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  8. Zhiwei Xu M.D.
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  9. Baiyong Shen M.D., Ph.D.
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Corresponding authors

Correspondence to Junjie Xie M.D., Zhiwei Xu M.D. or Baiyong Shen M.D., Ph.D..

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Disclosure

Weishen Wang, Ziyun Shen, Jun Zhang, Hao Chen, Xiaxing Deng, Chenghong Peng, Junjie Xie, Zhiwei Xu, and Baiyong Shen have declared no conflicts of interest.

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Wang, W., Shen, Z., Zhang, J. et al. A Novel Criterion for Lymph Nodes Dissection in Distal Pancreatectomy for Ductal Adenocarcinoma: A Population Study of the US SEER Database. Ann Surg Oncol 29, 1533–1539 (2022). https://doi.org/10.1245/s10434-021-10797-2

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  • DOI: https://doi.org/10.1245/s10434-021-10797-2

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