Yoon So Jeong, Hong Seung Soo, Park Boram, Kim Sung Hyun, Kang Chang Moo, Kim Kyung Sik, Shin Sang Hyun, Han In Woong, Heo Jin Seok, Hwang Ho Kyoung, Kim Hongbeom
Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Ann Surg Oncol. 2025 Aug 23. doi: 10.1245/s10434-025-18029-7.
Accurate LN examination is critical for staging and prognosis in pancreatic cancer. However, the ideal number of LNs required for precise staging and improved survival remains unclear. This study aimed to determine the optimal number of lymph nodes (LNs) to retrieve during pancreatectomy for pancreatic cancer to minimize false node-negative (false N0) rates and assess its impact on survival outcomes.
This retrospective cohort study analyzed data from patients undergoing curative-intent upfront surgery for pancreatic cancer at two tertiary centers in South Korea (2010-2021). An exploration cohort of 808 patients was used to identify LN retrieval thresholds, and the results were validated in an independent cohort of 444 patients. The study excluded patients who received neoadjuvant therapy or had fewer than two retrieved LNs. False N0 rates and 5 year overall survival were analyzed.
In the exploration cohort, examining 16 LNs reduced the false N0 rate to 18.9%, whereas in the validation cohort, retrieving 12 LNs resulted in a false N0 rate of 19.5%. Among the node-negative (N0) patients, retrieving up to 21 LNs was associated with improved 5 year overall survival. Differences in cutoff values between cohorts were attributed to demographic variations and inclusion of fewer LNs retrieved but higher detection of metastatic nodes in the validation cohort.
Retrieving a sufficient number of LNs during pancreatectomy is essential to reducing false N0 rates and improving survival outcomes for pancreatic cancer patients. These findings highlight the need for standardized LN evaluation protocols and support further prospective, multi-center studies to optimize staging accuracy.
准确的淋巴结检查对于胰腺癌的分期和预后至关重要。然而，精确分期和改善生存所需的理想淋巴结数量仍不明确。本研究旨在确定胰腺癌胰十二指肠切除术中获取的最佳淋巴结数量，以尽量减少假阴性淋巴结（假N0）率，并评估其对生存结果的影响。
这项回顾性队列研究分析了韩国两个三级中心（2010 - 2021年）接受胰腺癌根治性前期手术患者的数据。一个由808名患者组成的探索性队列用于确定淋巴结获取阈值，并在一个444名患者的独立队列中验证结果。该研究排除了接受新辅助治疗或获取的淋巴结少于两个的患者。分析了假N0率和5年总生存率。
在探索性队列中，检查16个淋巴结可将假N0率降至18.9%，而在验证性队列中，获取12个淋巴结导致假N0率为19.5%。在淋巴结阴性（N0）患者中，获取多达21个淋巴结与改善5年总生存率相关。队列之间截断值的差异归因于人口统计学差异以及验证性队列中获取的淋巴结较少但转移淋巴结的检出率较高。
在胰十二指肠切除术中获取足够数量的淋巴结对于降低胰腺癌患者的假N0率和改善生存结果至关重要。这些发现凸显了标准化淋巴结评估方案的必要性，并支持进一步开展前瞻性多中心研究以优化分期准确性。
