Murase Yoshiki, Esaki Minoru, Mizui Takahiro, Takamoto Takeshi, Nara Satoshi, Ban Daisuke, Hiraoka Nobuyoshi, Shimada Kazuaki
Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan.
Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan.
Surgery. 2025 Apr;180:109029. doi: 10.1016/j.surg.2024.109029. Epub 2024 Dec 31.
Lymph node dissection is required for many pancreatic neuroendocrine neoplasms. However, the need for such dissection has rarely been examined in detail by the tumor size, tumor location, or World Health Organization grading. The objective is to determine which characteristics of pancreatic neuroendocrine neoplasms require lymph node dissection, and to what extent lymph node dissection should be performed.
A retrospective review was performed of patients who had undergone pancreatectomy with lymph node dissection between 2000 and 2022. Frequency of lymph node metastases stratified by tumor size and grade, and efficacy index (calculated by multiplying the frequency of metastasis to the lymph node station by the 5-year overall survival rate of patients with metastasis to that station) for each lymph node station were evaluated.
Among 130 patients, 29 (22.3%) had lymph node metastases. Tumors larger than 2 cm had a 33.3% lymph node metastasis rate, whereas grade 1 and grade 2 neuroendocrine tumors had rates of 2.4% and 31.8%, respectively. In grade 1 neuroendocrine tumor, for pancreatic head tumor, only peripancreatic head lymph node had an efficacy index of 5.0. Pancreatic body and tail tumor had no lymph node metastases. In grade 2 neuroendocrine tumor, for pancreatic head tumor, peripancreatic and superior mesenteric artery lymph nodes had efficacy indexes of 29.2 and 14.3, respectively. For pancreatic body tumor, peridistal pancreatic lymph node had an efficacy index of 27.3, whereas for pancreatic tail tumor, peridistal pancreatic lymph node and splenic hilum lymph node had an efficacy index of 27.8 and 7.1, respectively.
The optimal extent of lymph node dissection for pancreatic neuroendocrine neoplasms should be determined by considering both the tumor size and grade for each tumor location.
许多胰腺神经内分泌肿瘤需要进行淋巴结清扫。然而，很少根据肿瘤大小、肿瘤位置或世界卫生组织分级对这种清扫的必要性进行详细研究。目的是确定胰腺神经内分泌肿瘤的哪些特征需要进行淋巴结清扫，以及应进行何种程度的淋巴结清扫。
对2000年至2022年间接受了胰腺切除术并进行淋巴结清扫的患者进行回顾性研究。评估按肿瘤大小和分级分层的淋巴结转移频率，以及每个淋巴结站的疗效指数（通过将转移至该淋巴结站的频率乘以转移至该站患者的5年总生存率来计算）。
130例患者中，29例（22.3%）有淋巴结转移。大于2cm的肿瘤淋巴结转移率为33.3%，而1级和2级神经内分泌肿瘤的转移率分别为2.4%和31.8%。在1级神经内分泌肿瘤中，对于胰头肿瘤，仅胰头周围淋巴结的疗效指数为5.0。胰体和胰尾肿瘤无淋巴结转移。在2级神经内分泌肿瘤中，对于胰头肿瘤，胰周和肠系膜上动脉淋巴结的疗效指数分别为29.2和14.3。对于胰体肿瘤，胰远端周围淋巴结的疗效指数为27.3，而对于胰尾肿瘤，胰远端周围淋巴结和脾门淋巴结的疗效指数分别为27.8和7.1。
胰腺神经内分泌肿瘤淋巴结清扫的最佳范围应通过考虑每个肿瘤位置的肿瘤大小和分级来确定。
