Impact of nodal staging for small bowel carcinoid: More is better!

Current guidelines for small bowel carcinoid (SBC) do not specify the extent lymph node (LN) staging required. Our aim was to determine whether analyzing more LNs in patients who undergo surgical resection for SBC correlated with improved survival. The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify patients undergoing surgical resection for histologically confirmed SBC from 1988- 2009. The number of LNs examined was categorized into 0, 1 to 6, 7 to 11 and 12+ nodes. Patient demographics and tumor characteristics were assessed by Logrank and Cox regression analysis. The median number of LNs examined for all 2796 patients was 4.00 (mean 6.83). For all stages of jejunal and ileal tumors examined, increased nodal sampling was associated with significantly improved survival (p < 0.001). On regression analysis, older age, non-white race, larger tumor size, higher T-stage and number of LNs examined were predictive of worse survival. For jejunal and ileal SBC, adequate lymphadenectomy, consisting of 12 lymph nodes, correlates with significantly improved survival. Presently, no guideline exists for SBC LN staging, but it is critical to ensure adequate surgical staging in patients who undergo resection for jejunal and ileal SBC.