Value Of Lymphadenectomy In Patients With Surgically Resected Grade 1 Pancreatic Neuroendocrine Tumors

Abstract Background: Although some factors that predict the prognosis in pancreatic neuroendocrine tumor (pNET) have been confirmed, the predictive value of lymph node metastasis (LNM) in the prognosis of pNETs remains conflicting and it is not clear whether regional lymphadenectomy should be performed in all grades of tumors.Methods: We included pNET patients undergoing surgery in Shanghai pancreatic cancer institute (SHPCI). The risk factors for survival were investigated by the Kaplan–Meier method and Cox regression model. We evaluated the predictors of LNM using Logistic regression.Results: For 206 patients in the SHPCI series, LNM was an independent prognostic factor for entire cohort suggested by multivariate Cox regression analysis. LNM (P = 0.002) predicted poorer overall survival (OS) in grade 2/3 cohort, but there is no significant association between LNM and OS in grade 1 cohort. Grade (P < 0.001) and size (P = 0.049) predicted LNM in entire cohort. Grade (P = 0.002) predicted LNM while regardless of size in grade 2/3 cohort. Conclusions: In grade1 tumors, LNM is not a predictor of OS, and lymphadenectomy is not recommended for these patients. In grade 2/3 tumors, LNM predict worse OS, and lymphadenectomy may bring survival benefit for these cases. Our findings indicated that lymphadenectomy should be performed in cases with grade 2/3 tumors but was not obligatory in cases with grade 1 tumors and it is reasonable to perform functional sparing surgery in patients with grade 1 tumors.