Institutional variants for lymph node counts after pancreatic resections

BackgroundLymph node (LN) counts from pancreatectomy are postulated as quality metric for surgical therapy of pancreatic malignancy.MethodsProspectively collected data from a single surgeon's pancreatectomy experience were analyzed for predictors of LN counts.ResultsOf 315 consecutive patients (54% female, median age: 65, range 18-88), 239 had a proven cancer diagnosis (76%). Operations included pancreatoduodenectomy (69%), distal pancreatectomy (26%), total pancreatectomy (1%) and others (4%). Patients were treated in 4 different tertiary cancer center settings (Institution A: 11%; B: 46%; C: 27%; D: 16%) with consistent regional dissection standards. Mean total LN counts differed between institutions for malignancies (A: 18, B: 13, C: 26, D: 26, p < 0.0001) and benign diseases (p = 0.003). At least 15 LNs were reported in 63% of cancer patients (institution range: 34-92%, p < 0.0001).ConclusionsPathologic processing should be standardized if LN numbers are to be adopted as quality metric for pancreatic cancer resections.