Zhang XF, Xue F, Dong DH, et al. - In this study, the prognostic role of metastatic lymph node (LN) number and the minimal number of LNs for optimal staging of patients with pancreatic neuroendocrine tumors (pNETs) was examined. Researchers used a multi-institutional database in order to correlate the number of LNM and total number of LN evaluated with recurrence-free survival (RFS) and overall survival (OS). They identified 854 patients who underwent resection; 233 of these (27.3%) had at least 1 LNM. A comparable worse RFS was recorded for patients with 1, 2, or 3 LNM vs patients with no nodal metastasis (5-year RFS, 1 LNM 65.6%, 2 LNM 68.2%, 3 LNM 63.2% vs 0 LNM 82.6%). In contrast, a worse RFS was recorded for patients with ≥ 4 LNM (proposed N2) vs patients who either had 1 to 3 LNM (proposed N1) or node-negative disease (5-year RFS, ≥ 4 LNM 43.5% vs 1–3 LNM 66.3%, 0 LNM 82.6%). In order to perform accurate staging of patients, regional lymphadenectomy of at least 8 lymph nodes was necessary. Optimal staging of patients was achieved with the proposed nodal staging of N0, N1, and N2.