ArticleJournal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract2018
Determining the Adequate Examined Lymph Node Count in Resected Ampullary Adenocarcinoma-A National Cohort Study.
Article in Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
2 citing papers in PubMed, 6 citations in OpenAlex.
- At least 16 lymph nodes are recommended to examine during pancreaticoduodenectomy in ampullary adenocarcinoma.American journal of cancer research · 2023Article
- Development and Validation of a New Lymph Node Ratio-Based Staging System for Ampullary Carcinoma After Curative Pancreaticoduodenectomy.Frontiers in oncology · 2021Article
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Authors and funding
10 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundThe evaluation of lymph node involvement is an essential component of cancer staging. Examining an inadequate number of lymph nodes potentially results in understaging. Current guidelines for lymph node retrieval for ampullary adenocarcinoma are based on data extrapolated from other periampullary malignancies and may not be applicable. The aim of this study was to determine the number of lymph nodes that should be examined in resection specimens to optimize staging in ampullary adenocarcinoma.
methodsPatients with ampullary adenocarcinoma from 2004 to 2014 were identified in the National Cancer Database. We determined the minimum examined lymph node (ELN) count by modeling each potential ELN count from 2 to 30 in a multivariable regression analysis and confirmed the results with a sensitivity analysis.
resultsWe identified 7451 patients of whom 52.2% had T3 or T4 disease and 51.4% had lymph node metastases. The median ELN count was 13 (interquartile range, 8-19). Increasing ELNs were independently associated with an increased likelihood of having positive nodal disease (odds ratio, 1.03; 95% confidence interval [CI], 1.03-1.04) and improved overall survival in both node-negative (hazard ratio [HR], 0.98; 95% CI, 0.97-0.99) and node-positive patients (HR, 0.99; 95% CI, 0.986-0.998). We determined that at least 17 lymph nodes should be examined. Overall survival for patients with 17 or more ELNs was superior than for those with fewer than 17 ELNs.
conclusionIncreasing ELNs were independently associated with improved overall survival in patients with resected ampullary adenocarcinoma. At least 17 lymph nodes should be examined for optimal nodal staging.
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