Lymph node yield as a measure of pancreatic cancer surgery quality
Introduction: Evaluated lymph node (ELN) yield has been established as a promising measure of surgical quality. Research has suggested that an ELN of at least 15 in pancreatic cancer patients is associated with improved survival and staging metrics. The aim of this study was to determine what impact...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-09-01
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| Series: | Surgery in Practice and Science |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S266626202200047X |
| _version_ | 1798032278377463808 |
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| author | Kevin Zhao Ayobami Fatunmbi Shengxuan Wang Katelyn Young Rebecca L. Hoffman Joseph A. Blansfield |
| author_facet | Kevin Zhao Ayobami Fatunmbi Shengxuan Wang Katelyn Young Rebecca L. Hoffman Joseph A. Blansfield |
| author_sort | Kevin Zhao |
| collection | DOAJ |
| description | Introduction: Evaluated lymph node (ELN) yield has been established as a promising measure of surgical quality. Research has suggested that an ELN of at least 15 in pancreatic cancer patients is associated with improved survival and staging metrics. The aim of this study was to determine what impact a high ELN yield of ≥15 has in a novel population. Methods: A retrospective cohort study was performed of patients with resectable, non-metastatic pancreatic adenocarcinoma who underwent neoadjuvant therapy followed by pancreatectomy using the National Cancer Database (NCDB 2004-2017). Patients who had <15 nodes examined and those who had ≥15 examined (high ELN) were compared. Univariate and multivariate analyses were performed to determine factors associated with ELN yield. A Cox proportional hazards model was used to identify factors associated with overall survival. Results: A total of 5,930 patients were included; 58% of patients had ≥15 lymph nodes examined. High ELN was associated with significant improvement in overall survival rates (p<0.004) and perioperative outcomes including post-operative stay (p<0.0001), 30-day unplanned readmission (p<0.028), and 90-day mortality (p<0.001). Patients who were treated at facilities with a high procedure-specific surgery volume were more likely to receive high ELN surgeries than those treated at facilities with a low volume (HR = 2.86[95% CI = 2.36-3.47]). Conclusions: An ELN yield of ≥15 was a significant measure of surgical quality in this novel population as it was associated with improvements in survival and perioperative outcomes. However, considerable harvest disparities exist at the facility level. |
| first_indexed | 2024-04-11T20:11:32Z |
| format | Article |
| id | doaj.art-4579ac24aee446ea9e7a62597623987a |
| institution | Directory Open Access Journal |
| issn | 2666-2620 |
| language | English |
| last_indexed | 2024-04-11T20:11:32Z |
| publishDate | 2022-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Surgery in Practice and Science |
| spelling | doaj.art-4579ac24aee446ea9e7a62597623987a2022-12-22T04:05:06ZengElsevierSurgery in Practice and Science2666-26202022-09-0110100103Lymph node yield as a measure of pancreatic cancer surgery qualityKevin Zhao0Ayobami Fatunmbi1Shengxuan Wang2Katelyn Young3Rebecca L. Hoffman4Joseph A. Blansfield5Geisinger Commonwealth School of Medicine, 525 Pine St., Scranton, PA 18510, United States; Corresponding author at: Geisinger Commonwealth School of Medicine, 525 Pine St., Scranton, PA 18510, United StatesGeisinger Medical Center, 100 N. Academy Ave., Danville, PA 17822, United StatesGeisinger Medical Center, 100 N. Academy Ave., Danville, PA 17822, United StatesGeisinger Medical Center, 100 N. Academy Ave., Danville, PA 17822, United StatesGeisinger Medical Center, 100 N. Academy Ave., Danville, PA 17822, United StatesGeisinger Medical Center, 100 N. Academy Ave., Danville, PA 17822, United StatesIntroduction: Evaluated lymph node (ELN) yield has been established as a promising measure of surgical quality. Research has suggested that an ELN of at least 15 in pancreatic cancer patients is associated with improved survival and staging metrics. The aim of this study was to determine what impact a high ELN yield of ≥15 has in a novel population. Methods: A retrospective cohort study was performed of patients with resectable, non-metastatic pancreatic adenocarcinoma who underwent neoadjuvant therapy followed by pancreatectomy using the National Cancer Database (NCDB 2004-2017). Patients who had <15 nodes examined and those who had ≥15 examined (high ELN) were compared. Univariate and multivariate analyses were performed to determine factors associated with ELN yield. A Cox proportional hazards model was used to identify factors associated with overall survival. Results: A total of 5,930 patients were included; 58% of patients had ≥15 lymph nodes examined. High ELN was associated with significant improvement in overall survival rates (p<0.004) and perioperative outcomes including post-operative stay (p<0.0001), 30-day unplanned readmission (p<0.028), and 90-day mortality (p<0.001). Patients who were treated at facilities with a high procedure-specific surgery volume were more likely to receive high ELN surgeries than those treated at facilities with a low volume (HR = 2.86[95% CI = 2.36-3.47]). Conclusions: An ELN yield of ≥15 was a significant measure of surgical quality in this novel population as it was associated with improvements in survival and perioperative outcomes. However, considerable harvest disparities exist at the facility level.http://www.sciencedirect.com/science/article/pii/S266626202200047XPancreatic adenocarcinomaLymph node harvestNeoadjuvant therapyEvaluated lymph node yieldSurgical quality improvementPerioperative outcomes |
| spellingShingle | Kevin Zhao Ayobami Fatunmbi Shengxuan Wang Katelyn Young Rebecca L. Hoffman Joseph A. Blansfield Lymph node yield as a measure of pancreatic cancer surgery quality Surgery in Practice and Science Pancreatic adenocarcinoma Lymph node harvest Neoadjuvant therapy Evaluated lymph node yield Surgical quality improvement Perioperative outcomes |
| title | Lymph node yield as a measure of pancreatic cancer surgery quality |
| title_full | Lymph node yield as a measure of pancreatic cancer surgery quality |
| title_fullStr | Lymph node yield as a measure of pancreatic cancer surgery quality |
| title_full_unstemmed | Lymph node yield as a measure of pancreatic cancer surgery quality |
| title_short | Lymph node yield as a measure of pancreatic cancer surgery quality |
| title_sort | lymph node yield as a measure of pancreatic cancer surgery quality |
| topic | Pancreatic adenocarcinoma Lymph node harvest Neoadjuvant therapy Evaluated lymph node yield Surgical quality improvement Perioperative outcomes |
| url | http://www.sciencedirect.com/science/article/pii/S266626202200047X |
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