Researchers recommend that at least 15 lymph nodes be removed and examined in patients with early gastric or pancreatic cancers. These results were recently published in the Archives of Surgery.
For accurate staging, or determination of extent of spread of gastric and pancreatic cancers, surgeons remove lymph nodes near the cancer. The lymph nodes are examined under a microscope to assess whether the cancer has spread to the lymph nodes, and if so, the extent of spread. Because treatment options are determined by the stage of the disease, an accurate assessment of spread to lymph nodes (nodal metastases) is imperative for optimal therapeutic choices.
Medical institutions that treat a high volume of patients with this disease or institutions affiliated with the National Comprehensive Cancer Network (NCCN) or National Cancer Institute (NCI), which follow strict guidelines, often tend to remove a larger number of lymph nodes during surgery than community centers or centers that treat a lower volume of patients with these diseases. It is currently not clear whether the removal of more nodes is associated with improved outcomes; however, patients treated at NCCN or NCI-designated centers or treated at medical centers that experience a high volume of these patients tend to have improved outcomes.
To further explore the possibility that the removal of more lymph nodes is associated with improved outcomes for patients diagnosed with gastric or pancreatic cancers, researchers evaluated outcomes among patients with gastric and pancreatic cancers who were treated at either high-volume or community medical centers (lower-volume centers). Included was data from the National Cancer Data Base from 2003-2004, which included more than 4,000 patients.
- Patients undergoing surgery at National Comprehensive Cancer Network (NCCN) or National Cancer Institute (NCI)-designated institutions had more lymph nodes removed and examined than those treated at a community medical center.
- Patients undergoing surgery at medical centers treating high volumes of patients with either gastric or pancreatic cancers also had more lymph nodes removed than those undergoing treatment at medical centers treating low volumes of these patients.
The researchers concluded that NCCN and NCI-designated centers and medical centers that treat a high volume of patients with pancreatic and gastric cancers tend to surgically remove more lymph nodes than community centers or medical centers that treat a low volume of patients with these diseases. The authors state: “Examination of at least 15 lymph nodes is an appropriate quality surveillance measure for gastric and pancreatic cancer because it is a feasible, achievable, and modifiable factor that is associated with improved outcomes.”
Patients diagnosed with gastric or pancreatic cancers may wish to speak with their physician regarding the status of the center at which they are receiving surgery. They may also wish to discuss their individual risks and benefits of greater removal of lymph nodes at the time of surgery.
Reference: Bilimoria K, Talamonti M, Wayne J, et al. Effect of hospital type and volume on lymph node evaluation for gastric and pancreatic cancer. Archives of Surgery. 2008;143:671-678.