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Objective: First, to assess the impact of the number of examined lymph nodes (ELNs) on staging and survival after distal pancreatectomy (DP) for pancreatic adenocarcinoma (PDAC). Second, to identify the minimum number of ELNs (MNELNs) ensuring an accurate detection of nodal involvement. Third, to reappraise the role of lymph node (LN) parameters, including N-status and lymph node ratio (LNR). Background: In contrast with pancreatoduodenectomy, information on LN staging and the MNELN required in DP is lacking. Methods: Patients undergoing DP for PDAC at 2 academic hospitals from 2000 through 2013 were retrospectively analyzed. The eighth edition of the American Joint Committee on Cancer staging system was used. The MNELN was estimated using the binomial probability law. Survival analyses were performed separately for node-negative and node-positive patients using univariable and multivariable models. Results: The study population consisted of 240 patients. The median number of ELN was 21, significantly lower in node-negative patients as compared with node-positive patients (18.5 vs 24.0; P = 0.001). The proportion of node-positive patients increased with increasing numbers of ELNs, whereas LNR showed an inverse trend. The estimated MNELN was 20. The number of ELN (≥ or <20) was an independent prognostic factor only in node-negative patients [odds ratio (OR) 3.23 for ELN <20), suggesting a stage migration effect. In node-positive patients, N2-class, but not LNR, was a significant predictor of survival at multivariable analysis (OR 1.68). Conclusion: The number of ELN affects nodal staging in body/tail PDAC. At least 20 LNs are required for correct staging. N-status is superior to LNR in predicting survival of node-positive patients.
Adult, Male, Distal pancreatectomy; Lymph nodes; Pancreatic adenocarcinoma; Pancreatic cancer, Adenocarcinoma, Middle Aged, Survival Analysis, Distal pancreatectomy; Lymph nodes; Pancreatic adenocarcinoma; Pancreatic cancer;, Pancreaticoduodenectomy, Pancreatic Neoplasms, Pancreatectomy, Humans, Lymph Node Excision, Female, Aged, Neoplasm Staging, Retrospective Studies
Adult, Male, Distal pancreatectomy; Lymph nodes; Pancreatic adenocarcinoma; Pancreatic cancer, Adenocarcinoma, Middle Aged, Survival Analysis, Distal pancreatectomy; Lymph nodes; Pancreatic adenocarcinoma; Pancreatic cancer;, Pancreaticoduodenectomy, Pancreatic Neoplasms, Pancreatectomy, Humans, Lymph Node Excision, Female, Aged, Neoplasm Staging, Retrospective Studies
citations This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically). | 53 | |
popularity This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network. | Top 10% | |
influence This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically). | Top 10% | |
impulse This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network. | Top 1% |