Predictors of Lymph Node Metastasis Warranting Lymphadenectomy in Pancreatic Neuroendocrine Tumors

Introduction: Pancreatic neuroendocrine tumors (PNETs) represent about 1–3% of all pancreatic tumors. Theoptimal extent of surgical resection remains uncertain, largely due to difficulties in reliably predicting lymph nodemetastasis (LNM) before surgery—a critical determinant of patient prognosis. Precise preoperative assessment ofLNM is essential to guide appropriate surgical planning and minimize unnecessary intervention in patients with alow risk of metastasis.Aim of work: To study the predictor factors of lymph made metastasis in pancreatic neuro endocrine tumour andhence the need for lymphadenectomy.Patients and methods: This retrospective study included patients who underwent curative-intent pancreaticresection 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 higherKi-67 index, grade 2–3 tumors, stage 3–4 disease, LVI, and perineural invasion. No significant association wasfound between LNM and tumor size, location, or type of surgery.Conclusion: Tumor biology—specifically grade, Ki-67 index, stage, LVI, and perineural invasion—are significantpredictors of LNM in PNETs. These factors should guide decisions regarding lymphadenectomy rather than tumorsize or location alone.