ArticleAnnals of surgery2025
Defining the Minimal and Optimal Thresholds for Lymph Node Resection and Examination for Intraductal Papillary Mucinous Neoplasm-derived Pancreatic Cancer: A Multicenter Retrospective Analysis.
Article in Annals of surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Informing Decision-making for Transected Margin Reresection in Intraductal Papillary Mucinous Neoplasm-derived Pancreatic Cancer: An International Multicenter Study.Annals of surgery · 2026Article
- Essential Update 2023/2024: Multidisciplinary Treatment for Invasive Intraductal Papillary Mucinous Carcinoma.Annals of gastroenterological surgery · 2025Review
- Knockdown of p53 Enhances LncRNA A2M-AS1 Inhibition of Pancreatic Cancer Progression via Regulating MAPK Pathway.Cancer medicine · 2025Article
- Defining and Predicting Early Recurrence for Optimal Treatment Strategies for Intraductal Papillary Mucinous Neoplasm-Derived Pancreatic Cancer: An International Multicenter Study.Annals of surgical oncology · 2025Article
- Evaluation of AJCC Nodal Staging for Intraductal Papillary Mucinous Neoplasm-Derived Pancreatic Ductal Adenocarcinoma.Annals of surgical oncology · 2024Article
- ASO Author Reflections: Intraductal Papillary Mucinous Neoplasm-Derived Pancreatic Cancer: A Need to Evaluate for Specific Staging Systems.Annals of surgical oncology · 2024Article
- An international multi-institutional validation of T1 sub-staging of intraductal papillary mucinous neoplasm-derived pancreatic cancer.Journal of the National Cancer Institute · 2024Article
- Significance of Pre-Treatment CALLY Score Combined with EBV-DNA Levels for Prognostication in Non-Metastatic Nasopharyngeal Cancer Patients: A Clinical Perspective.Journal of inflammation research · 2024Article
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15 authors.
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Abstract
objectiveTo establish minimal and optimal lymphadenectomy thresholds for intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) and evaluate their prognostic value.
backgroundCurrent guidelines recommend a minimum of 12 to 15 lymph nodes (LNs) in PDAC. This is largely based on pancreatic intraepithelial neoplasia (PanIN)-derived PDAC, a biologically distinct entity from IPMN-derived PDAC.
methodsMulticenter retrospective study including consecutive patients undergoing upfront surgery for IPMN-derived PDAC was conducted. The minimum cutoff for lymphadenectomy was defined as the maximum number of LNs where a significant node positivity difference was observed. Maximally selected log-rank statistic was used to derive the optimal lymphadenectomy cutoff (maximize survival). Kaplan-Meier curves and log-rank tests were used to analyze overall survival (OS) and recurrence-free survival (RFS). Multivariable Cox regression was used to determine hazard ratios (HRs) with 95% confidence intervals (CI).
resultsIn 341 patients with resected IPMN-derived PDAC, the minimum number of LNs needed to ensure accurate nodal staging was 10 ( P =0.040), whereas ≥20 LNs was the optimal number associated with improved OS (80.3 vs 37.2 months, P <0.001). Optimal lymphadenectomy was associated with improved OS [HR: 0.57 (95% CI: 0.39-0.83)] and RFS [HR: 0.70 (95% CI: 0.51-0.97)] on multivariable Cox regression. On subanalysis, the optimal lymphadenectomy cutoffs for pancreatoduodenectomy, distal pancreatectomy, and total pancreatectomy were 20 ( P <0.001), 23 ( P =0.160), and 25 ( P =0.008).
conclusionsIn IPMN-derived PDAC, lymphadenectomy with at least 10 lymph nodes mitigates understaging, and at least 20 lymph nodes is associated with improved survival. Specifically, for pancreatoduodenectomy and total pancreatectomy, 20 and 25 lymph nodes were the optimal cutoffs.
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