Predictors of Lymph Node Metastasis Warranting Lymphadenectomy in Pancreatic Neuroendocrine Tumors

Document Type : Original Article

Authors

Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt

10.21608/asjs.2025.408387.1222

Abstract

Introduction: Pancreatic neuroendocrine tumors (PNETs) represent about 1–3% of all pancreatic tumors. The
optimal extent of surgical resection remains uncertain, largely due to difficulties in reliably predicting lymph node
metastasis (LNM) before surgery—a critical determinant of patient prognosis. Precise preoperative assessment of
LNM is essential to guide appropriate surgical planning and minimize unnecessary intervention in patients with a
low risk of metastasis.
Aim of work: To study the predictor factors of lymph made metastasis in pancreatic neuro endocrine tumour and
hence the need for lymphadenectomy.
Patients and methods: This retrospective study included patients who underwent curative-intent pancreatic
resection for PNETs at the National Cancer Institute, Cairo University, from January 2004 to December 2024.
We analyzed associations between LNM and variables including age, tumor size, location, grade, Ki-67 index,
lymphovascular invasion (LVI), perineural invasion, and tumor stage.
Results: Among 28 patients, 9 (32.1%) had positive lymph nodes. LNM was significantly associated with higher
Ki-67 index, grade 2–3 tumors, stage 3–4 disease, LVI, and perineural invasion. No significant association was
found between LNM and tumor size, location, or type of surgery.
Conclusion: Tumor biology—specifically grade, Ki-67 index, stage, LVI, and perineural invasion—are significant
predictors of LNM in PNETs. These factors should guide decisions regarding lymphadenectomy rather than tumor
size or location alone.

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Ain Shams Journal of Surgery
Volume 18, Issue 4
October 2025
Pages 328-332

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