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Lymph node retrieval in pancreaticoduodenectomy specimens: does educating the pathologist matter?
D Rohan Jeyarajah1, Amit Khithani, Veeraiah Siripurapu
1Department of Surgery, Methodist Dallas Medical Center, Dallas, TX, USA; Department of Hepatopancreatobiliary Surgery, Methodist Dallas Medical Center, Dallas, TX, USA; Department of Cancer Center, Methodist Dallas Medical Center, Dallas, TX, USA.
Educating pathologists significantly increased lymph node retrieval in pancreaticoduodenectomy (PD) specimens. However, this did not improve lymph node ratio or positivity, suggesting the count alone may be a simplistic benchmark for surgical adequacy.
Area of Science:
- Oncology
- Surgical Pathology
- Gastroenterology
Background:
- Lymph node retrieval is a key metric for assessing surgical resection adequacy in pancreaticoduodenectomy (PD).
- Previous studies highlight the importance of lymph node counts in evaluating cancer resections.
- The impact of targeted pathologist education on nodal retrieval in PD remains an area for investigation.
Purpose of the Study:
- To evaluate the effect of specific pathologist education on lymph node retrieval rates in pancreaticoduodenectomy (PD).
- To determine if increased nodal retrieval impacts lymph node ratio and positivity rates.
Main Methods:
- Retrospective analysis of 98 pancreaticoduodenectomies (PDs) performed between September 2005 and March 2009.
- Group A: Pre-education (September 2005-March 2008).
- Group B: Post-education (April 2008-March 2009) following surgeon-led pathologist training on nodal count importance.
Main Results:
- Median lymph node retrieval increased significantly from 11 in Group A to 22 in Group B (P < 0.001).
- No significant changes were observed in the lymph node ratio (positive/total nodes).
- The median number of positive nodes and the overall node positivity rate remained unchanged between groups.
Conclusions:
- Pathologist education effectively increased lymph node retrieval in PD specimens.
- Despite increased retrieval, lymph node ratio and positivity rates were unaffected.
- Relying solely on lymph node count as a benchmark for surgical adequacy in PD may be an oversimplification.
