Greater lymph node retrieval and lymph node ratio impacts survival in resected pancreatic cancer

Surgical resection is the mainstay of pancreatic cancer treatment; however, the ideal lymphadenectomy remains unsettled. This study sought to determine whether number of examined lymph nodes (eLNs) and lymph node ratio (LNR) impact survival. The U.S. National Cancer Data Base (2003-2011) was reviewed for patients who underwent initial resection for clinical stage I and II pancreatic adenocarcinoma. Univariate and multivariate survival analyses were performed. Of 14,007 patients, 15.6% had 0-6 eLN, 27.1% 7-12, 13.4% 13-15, and 38.6% > 15 eLN. Median eLN was 11 for pancreaticoduodenectomy, and 14 for distal, total pancreatectomy, or other procedure. ELN >15 was associated with significantly improved survival in both node negative and positive disease (P 15 eLN had improved survival relative to 0-6 eLN (HR 0.87, P