Defining the Minimal and Optimal Thresholds for Lymph Node Resection and Examination for Intraductal Papillary Mucinous Neoplasm-derived Pancreatic Cancer: A Multicenter Retrospective Analysis.
[OBJECTIVE] To establish minimal and optimal lymphadenectomy thresholds for intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) and evaluate their prognostic
- p-value P =0.040
- p-value P <0.001
- 95% CI 0.39-0.83
- HR 0.57
APA
Habib JR, Rompen IF, et al. (2025). Defining the Minimal and Optimal Thresholds for Lymph Node Resection and Examination for Intraductal Papillary Mucinous Neoplasm-derived Pancreatic Cancer: A Multicenter Retrospective Analysis.. Annals of surgery, 282(6), 1052-1059. https://doi.org/10.1097/SLA.0000000000006295
MLA
Habib JR, et al.. "Defining the Minimal and Optimal Thresholds for Lymph Node Resection and Examination for Intraductal Papillary Mucinous Neoplasm-derived Pancreatic Cancer: A Multicenter Retrospective Analysis.." Annals of surgery, vol. 282, no. 6, 2025, pp. 1052-1059.
PMID
38606874
Abstract
[OBJECTIVE] To establish minimal and optimal lymphadenectomy thresholds for intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) and evaluate their prognostic value.
[BACKGROUND] Current guidelines recommend a minimum of 12 to 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.
[METHODS] Multicenter retrospective study including consecutive patients undergoing upfront surgery for IPMN-derived PDAC was conducted. The minimum cutoff 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 cutoff (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 (HRs) with 95% confidence intervals (CI).
[RESULTS] 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 months, 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 subanalysis, the optimal lymphadenectomy cutoffs for pancreatoduodenectomy, distal pancreatectomy, and total pancreatectomy were 20 ( P <0.001), 23 ( P =0.160), and 25 ( P =0.008).
[CONCLUSIONS] In IPMN-derived PDAC, lymphadenectomy with at least 10 lymph nodes mitigates understaging, and at least 20 lymph nodes is associated with improved survival. Specifically, for pancreatoduodenectomy and total pancreatectomy, 20 and 25 lymph nodes were the optimal cutoffs.
[BACKGROUND] Current guidelines recommend a minimum of 12 to 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.
[METHODS] Multicenter retrospective study including consecutive patients undergoing upfront surgery for IPMN-derived PDAC was conducted. The minimum cutoff 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 cutoff (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 (HRs) with 95% confidence intervals (CI).
[RESULTS] 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 months, 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 subanalysis, the optimal lymphadenectomy cutoffs for pancreatoduodenectomy, distal pancreatectomy, and total pancreatectomy were 20 ( P <0.001), 23 ( P =0.160), and 25 ( P =0.008).
[CONCLUSIONS] In IPMN-derived PDAC, lymphadenectomy with at least 10 lymph nodes mitigates understaging, and at least 20 lymph nodes is associated with improved survival. Specifically, for pancreatoduodenectomy and total pancreatectomy, 20 and 25 lymph nodes were the optimal cutoffs.
MeSH Terms
Humans; Retrospective Studies; Male; Female; Lymph Node Excision; Pancreatic Neoplasms; Aged; Middle Aged; Carcinoma, Pancreatic Ductal; Lymphatic Metastasis; Prognosis; Pancreatectomy; Neoplasm Staging; Adenocarcinoma, Mucinous; Aged, 80 and over; Lymph Nodes; Survival Rate
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- Adjuvant therapy after resection of intraductal papillary mucinous neoplasm-derived pancreatic cancer: A systematic review and meta-analysis.
- Recognizing IPMN-derived pancreatic cancer as a specific entity requiring prospective clinical studies: a call for international collaboration.
- Reply to: Adjuvant Chemotherapy on Resected Intraductal Papillary Mucinous Neoplasm-Derived Pancreatic Cancer: Addressing Statistical and Methodological Concerns in Survival Analysis.
- ASO Author Reflections: Resected Intraductal Papillary Mucinous Neoplasm-Derived Pancreatic Cancer: Early Recurrence and Patient-Tailored Management.