Accuracy of Staging Node-Negative Pancreas Cancer

Objective: To determine the optimal number of lymph nodes to examine for accurate staging of nodenegative pancreatic adenocarcinoma after pancreaticoduodenectomy.Design, Setting, and Patients: Data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program (1988-2002) were used to identify 3505 patients who underwent pancreaticoduodenectomy for adenocarcinoma of the pancreas, including 1150 patients who were pathologically node negative (pN0) and 584 patients with a single positive node (pN1a).Perioperative deaths were excluded.Univariate and multivariate survival analyses were performed.Main Outcome Measure: Examination of 15 lymph nodes appears to be optimal for accurate staging of nodenegative adenocarcinoma of the pancreas after pancreaticoduodenectomy.Results: The number of nodes examined ranged from 1 to 54 (median, 7 examined nodes).Univariate survival analysis demonstrated that dichotomizing the pN0 cohort on 15 or more examined lymph nodes resulted