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Systematic Review and Metaanalysis of Lymph Node Metastases of Resected Pancreatic Neuroendocrine Tumors

  • Pancreatic Tumors
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Abstract

Background

The optimal surgical strategy for pancreatic neuroendocrine tumors (PNETs) is unknown. However, current guidelines recommend a watch-and-wait strategy for small nonfunctional PNETs (NF-PNETs). The aim of this study is to investigate the risk stratification and prognostic significance of lymph node metastasis (LNM) of PNETs to guide decision-making for lymphadenectomy.

Patients and Methods

The MEDLINE and Web of Science databases were systematically searched for studies reporting either risk factors of LNM in resected PNETs or survival of patients with LNM. The weighted average incidence of LNM was calculated according to tumor characteristics. Random-effects metaanalyses were performed, and pooled hazard ratios (HR) and their 95% confidence intervals (CI) were calculated to determine the impact of LNM on overall survival (OS). In subgroup analyses, NF-PNETs were assessed.

Results

From a total of 5883 articles, 98 retrospective studies with 13,374 patients undergoing resection for PNET were included. In all PNETs, the weighted median rates of LNM were 11.5% for small (≤ 2 cm) PNETs and 15.8% for G1 PNETs. In NF-PNETs, the rates were 11.2% for small PNETs and 10.3% for G1 PNETs. LNM of all PNETs (HR 3.87, 95% CI 3.00–4.99, P < 0.001) and NF-PNETs (HR 4.98, 95% CI 2.81–8.83, P < 0.001) was associated with worse OS.

Conclusions

LNM is potentially prevalent even in small and well-differentiated PNETs and is associated with worse prognosis. A watch-and-wait strategy for small NF-PNETs should be reappraised, and oncologic resection with lymphadenectomy can be considered. Prospective and controlled studies are needed in the future.

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  1. Masayuki Tanaka MD, PhD

    Present address: Department of Surgery, Keio University, School of Medicine, Tokyo, Japan

Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany

    Masayuki Tanaka MD, PhD, Max Heckler MD, André L. Mihaljevic MD, Pascal Probst MD, Ulla Klaiber MD, Ulrike Heger MD, Simon Schimmack MD, Markus W. Büchler MD & Thilo Hackert MD

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Tanaka, M., Heckler, M., Mihaljevic, A.L. et al. Systematic Review and Metaanalysis of Lymph Node Metastases of Resected Pancreatic Neuroendocrine Tumors. Ann Surg Oncol 28, 1614–1624 (2021). https://doi.org/10.1245/s10434-020-08850-7

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