Extent of lymph node retrieval and pancreatic cancer survival: Information from a large US population database

Roderich E. Schwarz, David D. Smith

Research output: Contribution to journalArticle

150 Citations (Scopus)

Abstract

Background: Operative therapy of pancreatic cancer is associated with poor survival because of high recurrence rates after pancreatectomy. The effect of lymph node (LN) dissection on survival continues to be debated. Methods: A pancreatic cancer data set was created through structured queries to the Surveillance, Epidemiology, and End Results 1973 to 2000 database. Stage information was created according to 6th edition American Joint Committee on Cancer tumor-node-metastasis criteria, and the effect of LN number on survival was analyzed. Results: Out of a cohort of 20,631 patients with carcinomas of the exocrine pancreas, surgical details were available for 2,787 patients. Procedures included pancreatoduodenectomies (n = 1848; 66%), radical regional pancreatectomies (n = 516; 19%), other partial resections (n = 316; 11%), and total pancreatectomies (n = 107; 4%). For 1666 of these patients with complete clinicopathologic information, the median age was 66 years (range, 22-96 years), with an equal sex ratio. The median number of total LNs examined was 7 (range, 1-52), of positive LNs was 1 (range, 0-34), and of negative LNs was 6 (range, 0-30). Multivariate survival analysis yielded these prognostic variables: number of LNs examined, number of positive LNs, tumor size, extrapancreatic extension, radiotherapy (all P < .0001), and age (P = .0009). The greatest survival differences were observed for negative LN counts of 10 to 15. Conclusions: Stage-based survival prediction of pancreatic cancer is strongly influenced by total LN counts and numbers of negative LNs obtained. Although the mechanism remains unclear and could reflect confounding factors (margin status and institutional volume), an attempt to resect and examine at least 15 LNs to yield preferably between 10 and 15 negative LNs seems sensible for curative-intent pancreatectomy. Published by Springer Science+Business Media, Inc.

Original languageEnglish (US)
Pages (from-to)1189-1200
Number of pages12
JournalAnnals of Surgical Oncology
Volume13
Issue number9
DOIs
StatePublished - Sep 2006

Fingerprint

Pancreatic Neoplasms
Pancreatectomy
Lymph Nodes
Databases
Survival
Population
Exocrine Pancreas
Neoplasms
Pancreaticoduodenectomy
Sex Ratio
Survival Analysis
Lymph Node Excision
Epidemiology
Radiotherapy
Multivariate Analysis
Neoplasm Metastasis
Carcinoma
Recurrence
Therapeutics

Keywords

  • Lymph node counts
  • Lymphadenectomy
  • Pancreatic cancer
  • Postoperative survival
  • SEER population data

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Extent of lymph node retrieval and pancreatic cancer survival : Information from a large US population database. / Schwarz, Roderich E.; Smith, David D.

In: Annals of Surgical Oncology, Vol. 13, No. 9, 09.2006, p. 1189-1200.

Research output: Contribution to journalArticle

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abstract = "Background: Operative therapy of pancreatic cancer is associated with poor survival because of high recurrence rates after pancreatectomy. The effect of lymph node (LN) dissection on survival continues to be debated. Methods: A pancreatic cancer data set was created through structured queries to the Surveillance, Epidemiology, and End Results 1973 to 2000 database. Stage information was created according to 6th edition American Joint Committee on Cancer tumor-node-metastasis criteria, and the effect of LN number on survival was analyzed. Results: Out of a cohort of 20,631 patients with carcinomas of the exocrine pancreas, surgical details were available for 2,787 patients. Procedures included pancreatoduodenectomies (n = 1848; 66{\%}), radical regional pancreatectomies (n = 516; 19{\%}), other partial resections (n = 316; 11{\%}), and total pancreatectomies (n = 107; 4{\%}). For 1666 of these patients with complete clinicopathologic information, the median age was 66 years (range, 22-96 years), with an equal sex ratio. The median number of total LNs examined was 7 (range, 1-52), of positive LNs was 1 (range, 0-34), and of negative LNs was 6 (range, 0-30). Multivariate survival analysis yielded these prognostic variables: number of LNs examined, number of positive LNs, tumor size, extrapancreatic extension, radiotherapy (all P < .0001), and age (P = .0009). The greatest survival differences were observed for negative LN counts of 10 to 15. Conclusions: Stage-based survival prediction of pancreatic cancer is strongly influenced by total LN counts and numbers of negative LNs obtained. Although the mechanism remains unclear and could reflect confounding factors (margin status and institutional volume), an attempt to resect and examine at least 15 LNs to yield preferably between 10 and 15 negative LNs seems sensible for curative-intent pancreatectomy. Published by Springer Science+Business Media, Inc.",
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N2 - Background: Operative therapy of pancreatic cancer is associated with poor survival because of high recurrence rates after pancreatectomy. The effect of lymph node (LN) dissection on survival continues to be debated. Methods: A pancreatic cancer data set was created through structured queries to the Surveillance, Epidemiology, and End Results 1973 to 2000 database. Stage information was created according to 6th edition American Joint Committee on Cancer tumor-node-metastasis criteria, and the effect of LN number on survival was analyzed. Results: Out of a cohort of 20,631 patients with carcinomas of the exocrine pancreas, surgical details were available for 2,787 patients. Procedures included pancreatoduodenectomies (n = 1848; 66%), radical regional pancreatectomies (n = 516; 19%), other partial resections (n = 316; 11%), and total pancreatectomies (n = 107; 4%). For 1666 of these patients with complete clinicopathologic information, the median age was 66 years (range, 22-96 years), with an equal sex ratio. The median number of total LNs examined was 7 (range, 1-52), of positive LNs was 1 (range, 0-34), and of negative LNs was 6 (range, 0-30). Multivariate survival analysis yielded these prognostic variables: number of LNs examined, number of positive LNs, tumor size, extrapancreatic extension, radiotherapy (all P < .0001), and age (P = .0009). The greatest survival differences were observed for negative LN counts of 10 to 15. Conclusions: Stage-based survival prediction of pancreatic cancer is strongly influenced by total LN counts and numbers of negative LNs obtained. Although the mechanism remains unclear and could reflect confounding factors (margin status and institutional volume), an attempt to resect and examine at least 15 LNs to yield preferably between 10 and 15 negative LNs seems sensible for curative-intent pancreatectomy. Published by Springer Science+Business Media, Inc.

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