Increased pancreatic cancer survival with greater lymph node retrieval in the National Cancer Data Base

Am J Surg. 2017 Sep;214(3):442-449. doi: 10.1016/j.amjsurg.2017.06.036. Epub 2017 Jul 1.

Abstract

Background: We evaluated the role of lymph node (LN) retrieval in pancreatic adenocarcinoma (PA) patients undergoing pancreaticoduodenectomy (PD).

Methods: We utilized the National Cancer Data Base; Cox regression models and logistic regression models were used for statistical evaluation.

Results: We evaluated 26,792 patients with PA who underwent PD. The mean LN retrieved in LN(-) patients was 10.8 vs 14.4 for LN(+) patients (P < 0.0001). Greater LN retrieval is an independent predictor of a negative microscopic margin and decreased length of stay. The median survival of LN(-) patients exceeded that of LN(+) patients (24.5 vs 15.1 months, P < 0.0001). Increasing LN retrieval is a significant predictor of survival in all patients, and in LN(-) patients. The relationship of increased LN retrieval and enhanced survival is a nearly linear trend.

Conclusions: Rather than demonstrating an inflection point that defines the extent of adequate lymphadenectomy, this dataset demonstrates an incremental relationship between LN retrieval and survival.

Keywords: Lymphadenectomy; National Cancer Data Base; Pancreatic cancer.

MeSH terms

  • Adenocarcinoma / mortality*
  • Adenocarcinoma / pathology
  • Adenocarcinoma / surgery*
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Databases, Factual
  • Female
  • Humans
  • Lymph Node Excision*
  • Lymph Nodes / pathology*
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Pancreatic Neoplasms / mortality*
  • Pancreatic Neoplasms / pathology
  • Pancreatic Neoplasms / surgery*
  • Pancreaticoduodenectomy
  • Retrospective Studies
  • Survival Analysis
  • Survival Rate
  • United States
  • Young Adult