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Optimal Lymphadenectomy in Small Bowel Neuroendocrine Tumors: Analysis of the NCDB

  • 2017 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Current National Comprehensive Cancer Network guidelines for resectable small bowel neuroendocrine tumors (NETs) recommend regional lymphadenectomy. However, no consensus exists on the optimal nodal harvest.

Methods

The National Cancer Database was queried for patients with resectable small bowel NETs (1998–2013). Patients with metastatic disease and missing lymph node harvest data were excluded. We performed logistic regression of factors determining nodal positivity and multivariable survival analyses.

Results

Of 11,852 patients, 81.8% underwent lymphadenectomy. 79.3% were node positive (N+) and 46.9% of patients had tumors < 1 cm. Independent predictors of N+ were large tumor size, ileal location, and neuroendocrine carcinoma histology. Logistic regression found no difference between observed and expected proportions of N+ patients with lymphadenectomy greater than or equal to eight nodes. Lower metastatic node ratio predicted improved survival on multivariable analysis and is associated with high-volume institutions.

Conclusion

Small bowel NETs have high rates of nodal metastasis, even in patients with small tumors, and many patients do not undergo lymphadenectomy despite the clear benefit. Lymphadenectomy of eight nodes is optimal to identify N+ patients. Additionally, minimizing metastatic node ratio with complete regional lymphadenectomy is associated with improved survival in these patients.

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Acknowledgements

The authors acknowledge Jill J. Jurgensen for editing assistance.

The authors acknowledge I’sis N. Perry for providing administrative support.

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Authors and Affiliations

  1. Levine Cancer Institute, Division of Surgical Oncology, Department of Surgery, Carolinas Medical Center, 1021 Morehead Medical Drive #6100, Charlotte, NC, 28204, USA

    Benjamin M. Motz, Patrick D. Lorimer, Joshua S. Hill & Jonathan C. Salo

  2. Levine Cancer Institute, Department of Biostatistics, Carolinas Medical Center, Charlotte, NC, USA

    Danielle Boselli

Authors
  1. Benjamin M. Motz
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  2. Patrick D. Lorimer
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  3. Danielle Boselli
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  4. Joshua S. Hill
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  5. Jonathan C. Salo
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Contributions

Study conception and design: Salo, Hill, and Motz.

Acquisition of data: Salo, Motz, and Boselli.

Analysis and interpretation of data: Salo, Motz, Boselli, and Lorimer.

Drafting of manuscript: Motz, Lorimer, Salo, and Boselli.

Critical revision: Motz, Lorimer, Salo, and Hill.

Approval of final version to be submitted: all authors.

Corresponding author

Correspondence to Jonathan C. Salo.

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Motz, B.M., Lorimer, P.D., Boselli, D. et al. Optimal Lymphadenectomy in Small Bowel Neuroendocrine Tumors: Analysis of the NCDB. J Gastrointest Surg 22, 117–123 (2018). https://doi.org/10.1007/s11605-017-3524-9

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  • DOI: https://doi.org/10.1007/s11605-017-3524-9

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