Premium
A novel stratification of mesenteric mass involvement as a predictor of challenging mesenteric lymph node dissection by minimally invasive approach for ileal neuroendocrine tumors
Author(s) -
Kasai Yosuke,
Mahuron Kelly,
Hirose Kenzo,
Corvera Carlos U.,
Kim Grace E.,
Hope Thomas A.,
Shih Brandon E.,
Warren Robert S.,
Bergsland Emily K.,
Nakakura Eric K.
Publication year - 2020
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25930
Subject(s) - medicine , lymph node , dissection (medical) , general surgery , radiology
Background and Objectives We classified the extent of mesenteric mass (MM) involvement that predicts challenging mesenteric lymph node dissection (mLND) by minimally invasive surgery (MIS) for ileal neuroendocrine tumors (i‐NETs). Methods Patients who underwent surgery for i‐NETs were retrospectively reviewed. MM involvement was classified as region‐0: no MM; region‐1: >2 cm from the origins of the ileocolic artery/vein; region‐2: ≤2 cm from the origins; and region‐3: more proximal superior mesenteric artery/vein. Logistic regression analysis was used to evaluate the predictive value of MM regions for gross positive mesenteric margin (mR2) and/or conversion among the MIS cohort. The open surgery cohort was used as a reference for mR2 rates. Results Of 108 patients, 83 patients (77%) underwent MIS. MMs in region‐2 and region‐3 were independent risk factors for mR2 and/or conversion (odds ratio [95% confidence interval]: 4.25 [1.17‐16.4] and 8.51 × 10 7 [11.0‐], respectively, against regions‐0 and 1]. mR2 rates of MIS and open surgery cohorts per region did not differ significantly (4% and 7% for regions‐0 and 1; 17% and 25% for region‐2; and 100% and 83% for region‐3). Conclusions The novel stratification of MM regions was predictive of challenging mLND by MIS. Surgeons should have a low threshold for conversion for MMs in proximal regions.