Defining the Minimal and Optimal Thresholds for Lymph Node Resection and Examination for Intraductal Papillary Mucinous Neoplasm Derived Pancreatic Cancer: A Multicenter Retrospective Analysis
To establish minimal and optimal lymphadenectomy thresholds for intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) and evaluate their prognostic value. Current guidelines recommend a minimum of 12-15 lymph nodes (LNs) in PDAC. This is largely based on panc...
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| Veröffentlicht in: | Annals of surgery 2024-04 |
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| creator | Habib, Joseph R Rompen, Ingmar F Kaslow, Sarah R Grewal, Mahip Andel, Paul C M Zhang, Shuang Hewitt, D Brock Cohen, Steven M van Santvoort, Hjalmar C Besselink, Marc G Molenaar, I Quintus He, Jin Wolfgang, Christopher L Javed, Ammar A Daamen, Lois A |
| description | To establish minimal and optimal lymphadenectomy thresholds for intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) and evaluate their prognostic value.
Current guidelines recommend a minimum of 12-15 lymph nodes (LNs) in PDAC. This is largely based on pancreatic intraepithelial neoplasia (PanIN)-derived PDAC, a biologically distinct entity from IPMN-derived PDAC.
Multicenter retrospective study including consecutive patients undergoing upfront surgery for IPMN-derived PDAC was conducted. The minimum cut-off for lymphadenectomy was defined as the maximum number of LNs where a significant node positivity difference was observed. Maximally selected log-rank statistic was used to derive the optimal lymphadenectomy cut-off (maximize survival). Kaplan-Meier curves and log-rank tests were used to analyze overall survival (OS) and recurrence-free survival (RFS). Multivariable Cox-regression was used to determine hazard ratios (HR) with 95% confidence intervals (95%CI).
In 341 patients with resected IPMN-derived PDAC, the minimum number of LNs needed to ensure accurate nodal staging was 10 (P=0.040), whereas ≥20 LNs was the optimal number associated with improved OS (80.3 vs. 37.2 mo, P |
| doi_str_mv | 10.1097/SLA.0000000000006295 |
| format | Article |
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Current guidelines recommend a minimum of 12-15 lymph nodes (LNs) in PDAC. This is largely based on pancreatic intraepithelial neoplasia (PanIN)-derived PDAC, a biologically distinct entity from IPMN-derived PDAC.
Multicenter retrospective study including consecutive patients undergoing upfront surgery for IPMN-derived PDAC was conducted. The minimum cut-off for lymphadenectomy was defined as the maximum number of LNs where a significant node positivity difference was observed. Maximally selected log-rank statistic was used to derive the optimal lymphadenectomy cut-off (maximize survival). Kaplan-Meier curves and log-rank tests were used to analyze overall survival (OS) and recurrence-free survival (RFS). Multivariable Cox-regression was used to determine hazard ratios (HR) with 95% confidence intervals (95%CI).
In 341 patients with resected IPMN-derived PDAC, the minimum number of LNs needed to ensure accurate nodal staging was 10 (P=0.040), whereas ≥20 LNs was the optimal number associated with improved OS (80.3 vs. 37.2 mo, P<0.001). Optimal lymphadenectomy was associated with improved OS [HR:0.57 (95%CI 0.39-0.83)] and RFS [HR:0.70 (95%CI 0.51-0.97)] on multivariable Cox-regression. On sub-analysis the optimal lymphadenectomy cut-offs for pancreatoduodenectomy, distal pancreatectomy, and total pancreatectomy were 20 (P<0.001), 23 (P=0.160), and 25 (P=0.008).
In IPMN-derived PDAC, lymphadenectomy with at least 10 lymph nodes mitigates under-staging, and at least 20 lymph nodes is associated with the improved survival. Specifically, for pancreatoduodenectomy and total pancreatectomy, 20 and 25 lymph nodes were the optimal cut-offs.</description><identifier>ISSN: 0003-4932</identifier><identifier>ISSN: 1528-1140</identifier><identifier>EISSN: 1528-1140</identifier><identifier>DOI: 10.1097/SLA.0000000000006295</identifier><identifier>PMID: 38606874</identifier><language>eng</language><publisher>United States</publisher><ispartof>Annals of surgery, 2024-04</ispartof><rights>Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38606874$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Habib, Joseph R</creatorcontrib><creatorcontrib>Rompen, Ingmar F</creatorcontrib><creatorcontrib>Kaslow, Sarah R</creatorcontrib><creatorcontrib>Grewal, Mahip</creatorcontrib><creatorcontrib>Andel, Paul C M</creatorcontrib><creatorcontrib>Zhang, Shuang</creatorcontrib><creatorcontrib>Hewitt, D Brock</creatorcontrib><creatorcontrib>Cohen, Steven M</creatorcontrib><creatorcontrib>van Santvoort, Hjalmar C</creatorcontrib><creatorcontrib>Besselink, Marc G</creatorcontrib><creatorcontrib>Molenaar, I Quintus</creatorcontrib><creatorcontrib>He, Jin</creatorcontrib><creatorcontrib>Wolfgang, Christopher L</creatorcontrib><creatorcontrib>Javed, Ammar A</creatorcontrib><creatorcontrib>Daamen, Lois A</creatorcontrib><title>Defining the Minimal and Optimal Thresholds for Lymph Node Resection and Examination for Intraductal Papillary Mucinous Neoplasm Derived Pancreatic Cancer: A Multicenter Retrospective Analysis</title><title>Annals of surgery</title><addtitle>Ann Surg</addtitle><description>To establish minimal and optimal lymphadenectomy thresholds for intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) and evaluate their prognostic value.
Current guidelines recommend a minimum of 12-15 lymph nodes (LNs) in PDAC. This is largely based on pancreatic intraepithelial neoplasia (PanIN)-derived PDAC, a biologically distinct entity from IPMN-derived PDAC.
Multicenter retrospective study including consecutive patients undergoing upfront surgery for IPMN-derived PDAC was conducted. The minimum cut-off for lymphadenectomy was defined as the maximum number of LNs where a significant node positivity difference was observed. Maximally selected log-rank statistic was used to derive the optimal lymphadenectomy cut-off (maximize survival). Kaplan-Meier curves and log-rank tests were used to analyze overall survival (OS) and recurrence-free survival (RFS). Multivariable Cox-regression was used to determine hazard ratios (HR) with 95% confidence intervals (95%CI).
In 341 patients with resected IPMN-derived PDAC, the minimum number of LNs needed to ensure accurate nodal staging was 10 (P=0.040), whereas ≥20 LNs was the optimal number associated with improved OS (80.3 vs. 37.2 mo, P<0.001). Optimal lymphadenectomy was associated with improved OS [HR:0.57 (95%CI 0.39-0.83)] and RFS [HR:0.70 (95%CI 0.51-0.97)] on multivariable Cox-regression. On sub-analysis the optimal lymphadenectomy cut-offs for pancreatoduodenectomy, distal pancreatectomy, and total pancreatectomy were 20 (P<0.001), 23 (P=0.160), and 25 (P=0.008).
In IPMN-derived PDAC, lymphadenectomy with at least 10 lymph nodes mitigates under-staging, and at least 20 lymph nodes is associated with the improved survival. Specifically, for pancreatoduodenectomy and total pancreatectomy, 20 and 25 lymph nodes were the optimal cut-offs.</description><issn>0003-4932</issn><issn>1528-1140</issn><issn>1528-1140</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNpdUV1P3DAQtFArOA7-QVX5sS8BO_ad476djk_pgKrAc-TYm56rxEntBHH_jp_G3gFVVb94vZrZ8ewQ8oWzE860Or1fLU7YP2ee69kemfBZXmScS_aJTLArMqlFfkAOU_rNGJcFU_vkQBRzNi-UnJCXM6h98OEXHdZAb7BsTUNNcPSuH3b1wzpCWneNS7TuIl1t2n5NbzsH9CcksIPvwg5__mxaH8zuvQVehyEaN9oBZ_wwvW8aEzf0ZrQ-dGOit9D1jUktPYPon8AhJtgIyLd0iSXE73SB8AYbEAaIKDfELvVbySegi2CaTfLpiHyuTZPg-P2ekseL84flVba6u7xeLlaZ5Wg7M0aYmZac55aDc1KrXCltZVVIJyVTleJa1roqdKF0IaWutDZaKDevZrYCJabk29vcPnZ_RkhD2fpkAV0FQD-lYAJpXOG6p0S-QS3-N0Woyz7iKuOm5KzcZldiduX_2SHt67vCWLXg_pI-whKvWEuXyQ</recordid><startdate>20240412</startdate><enddate>20240412</enddate><creator>Habib, Joseph R</creator><creator>Rompen, Ingmar F</creator><creator>Kaslow, Sarah R</creator><creator>Grewal, Mahip</creator><creator>Andel, Paul C M</creator><creator>Zhang, Shuang</creator><creator>Hewitt, D Brock</creator><creator>Cohen, Steven M</creator><creator>van Santvoort, Hjalmar C</creator><creator>Besselink, Marc G</creator><creator>Molenaar, I Quintus</creator><creator>He, Jin</creator><creator>Wolfgang, Christopher L</creator><creator>Javed, Ammar A</creator><creator>Daamen, Lois A</creator><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20240412</creationdate><title>Defining the Minimal and Optimal Thresholds for Lymph Node Resection and Examination for Intraductal Papillary Mucinous Neoplasm Derived Pancreatic Cancer: A Multicenter Retrospective Analysis</title><author>Habib, Joseph R ; Rompen, Ingmar F ; Kaslow, Sarah R ; Grewal, Mahip ; Andel, Paul C M ; Zhang, Shuang ; Hewitt, D Brock ; Cohen, Steven M ; van Santvoort, Hjalmar C ; Besselink, Marc G ; Molenaar, I Quintus ; He, Jin ; Wolfgang, Christopher L ; Javed, Ammar A ; Daamen, Lois A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1014-aa3a594112c1edd4972779c4b84d4407b7194f9b898798449b99a937d6b5cbe73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Habib, Joseph R</creatorcontrib><creatorcontrib>Rompen, Ingmar F</creatorcontrib><creatorcontrib>Kaslow, Sarah R</creatorcontrib><creatorcontrib>Grewal, Mahip</creatorcontrib><creatorcontrib>Andel, Paul C M</creatorcontrib><creatorcontrib>Zhang, Shuang</creatorcontrib><creatorcontrib>Hewitt, D Brock</creatorcontrib><creatorcontrib>Cohen, Steven M</creatorcontrib><creatorcontrib>van Santvoort, Hjalmar C</creatorcontrib><creatorcontrib>Besselink, Marc G</creatorcontrib><creatorcontrib>Molenaar, I Quintus</creatorcontrib><creatorcontrib>He, Jin</creatorcontrib><creatorcontrib>Wolfgang, Christopher L</creatorcontrib><creatorcontrib>Javed, Ammar A</creatorcontrib><creatorcontrib>Daamen, Lois A</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Habib, Joseph R</au><au>Rompen, Ingmar F</au><au>Kaslow, Sarah R</au><au>Grewal, Mahip</au><au>Andel, Paul C M</au><au>Zhang, Shuang</au><au>Hewitt, D Brock</au><au>Cohen, Steven M</au><au>van Santvoort, Hjalmar C</au><au>Besselink, Marc G</au><au>Molenaar, I Quintus</au><au>He, Jin</au><au>Wolfgang, Christopher L</au><au>Javed, Ammar A</au><au>Daamen, Lois A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Defining the Minimal and Optimal Thresholds for Lymph Node Resection and Examination for Intraductal Papillary Mucinous Neoplasm Derived Pancreatic Cancer: A Multicenter Retrospective Analysis</atitle><jtitle>Annals of surgery</jtitle><addtitle>Ann Surg</addtitle><date>2024-04-12</date><risdate>2024</risdate><issn>0003-4932</issn><issn>1528-1140</issn><eissn>1528-1140</eissn><abstract>To establish minimal and optimal lymphadenectomy thresholds for intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) and evaluate their prognostic value.
Current guidelines recommend a minimum of 12-15 lymph nodes (LNs) in PDAC. This is largely based on pancreatic intraepithelial neoplasia (PanIN)-derived PDAC, a biologically distinct entity from IPMN-derived PDAC.
Multicenter retrospective study including consecutive patients undergoing upfront surgery for IPMN-derived PDAC was conducted. The minimum cut-off for lymphadenectomy was defined as the maximum number of LNs where a significant node positivity difference was observed. Maximally selected log-rank statistic was used to derive the optimal lymphadenectomy cut-off (maximize survival). Kaplan-Meier curves and log-rank tests were used to analyze overall survival (OS) and recurrence-free survival (RFS). Multivariable Cox-regression was used to determine hazard ratios (HR) with 95% confidence intervals (95%CI).
In 341 patients with resected IPMN-derived PDAC, the minimum number of LNs needed to ensure accurate nodal staging was 10 (P=0.040), whereas ≥20 LNs was the optimal number associated with improved OS (80.3 vs. 37.2 mo, P<0.001). Optimal lymphadenectomy was associated with improved OS [HR:0.57 (95%CI 0.39-0.83)] and RFS [HR:0.70 (95%CI 0.51-0.97)] on multivariable Cox-regression. On sub-analysis the optimal lymphadenectomy cut-offs for pancreatoduodenectomy, distal pancreatectomy, and total pancreatectomy were 20 (P<0.001), 23 (P=0.160), and 25 (P=0.008).
In IPMN-derived PDAC, lymphadenectomy with at least 10 lymph nodes mitigates under-staging, and at least 20 lymph nodes is associated with the improved survival. Specifically, for pancreatoduodenectomy and total pancreatectomy, 20 and 25 lymph nodes were the optimal cut-offs.</abstract><cop>United States</cop><pmid>38606874</pmid><doi>10.1097/SLA.0000000000006295</doi></addata></record> |
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| title | Defining the Minimal and Optimal Thresholds for Lymph Node Resection and Examination for Intraductal Papillary Mucinous Neoplasm Derived Pancreatic Cancer: A Multicenter Retrospective Analysis |
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