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Tumor Size Correlates with Lymph Node Metastasis in Primary Pancreatic Endocrine Neoplasms
Trevor Ellison*1, Kelly Olino1, John L. Cameron1, Ralph H. Hruban2, Chanjuan Shi2, Marta M. Gilson1, Michael a. Choti1, Timothy M. Pawlik1, Richard D. Schulick1, Christopher L. Wolfgang1, Barish H. Edil1
1General Surgery, Johns Hopkins, Baltimore, MD; 2Pathology, Johns Hopkins, Baltimore, MD
INTRODUCTION: Well-differentiated pancreatic endocrine neoplasm (PEN) is a rare entity in which surgical resection is the only chance for cure. The extent of resection and lymphadenectomy remains controversial with few clinical parameters available to guide surgical planning. We hypothesize that the size of PEN will correlate with lymph node metastasis.METHODS: This study was a retrospective review of our institution’s prospectively collected database on patients who have undergone pancreatic surgery from May 1984 to August 2009. We used the Cochran-Mantel-Haenszel test for nonzero correlation between tumor size and positive lymph node status.RESULTS: We identified 511 patients who had a PEN resected. Of the 511 patients, we found 365 with PEN as their worst diagnosis as well as having at least one lymph node in their pathology specimen. Tumor size correlated with lymph node metastases in the following manner: < 1 cm, 15%; 1 - < 2cm, 14%; 2 - < 3cm, 41%; 3 - < 4cm, 61%; 4 - < 5cm, 75%; 5cm or more, 54%. There was a statistically significant correlation between tumor size and lymph node metastases (p< 0.0001).CONCLUSION: Size of PEN correlates with lymph node metastasis. Remarkably, even small (<1cm) PENs can metastasize to lymph nodes. Therefore surgical resection with appropriate lymphadenectomy should be considered for all PENs regardless of their size.
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