BACKGROUND: The role of extended resections in the management of advanced pancreatic neuroendocrine tumors (PNETs) is not well defined. METHODS: Between 1995 and 2012, 134 patients with PNET underwent isolated (isoPNET group: 91 patients) or extended pancreatic resection (synchronous liver metastases and/or adjacent organs) (advPNET group: 43 patients). RESULTS: The associated resections included 27 hepatectomies, 9 vascular resections, 12 colectomies, 10 gastrectomies, 4 nephrectomies, 4 adrenalectomies, and 3 duodenojejunal resections. R0 was achieved in 41 patients (95%) in the advPNET. The rates of T3-T4 (73 vs 16%; p < .0001) and N+ (35 vs 13%; p = .007) were higher in the advPNET group. Mortality (5 vs 2%) and major morbidity (21 vs 19%) rates were similar between the 2 groups. The 5-year overall survival (OS) of the series was 87% in the isoPNET group and 66% in the advPNET group (p = .006). Only patients with both locally advanced disease and liver metastases showed worse survival (p = .0003). The advPNET group developed recurrence earlier [disease-free survival (DFS) at 5 years: 26 vs 81%; p < .001]. In univariate analysis, negative prognostic factors of survival were: poor degree of differentiation (p < .001), liver metastasis (p = .011), NE carcinoma (p < .001), and resection of adjacent organs (p = .013). The multivariate analysis did not highlight any factor that influenced OS. In multivariate analysis independent DFS factors were a poor degree of differentiation (p = .03) and the European Neuroendocrine Tumor Society stage (p = .01). CONCLUSIONS: An aggressive surgical approach for locally advanced or metastatic tumors is safe and offers long-term survival.
BACKGROUND: The role of extended resections in the management of advanced pancreatic neuroendocrine tumors (PNETs) is not well defined. METHODS: Between 1995 and 2012, 134 patients with PNET underwent isolated (isoPNET group: 91 patients) or extended pancreatic resection (synchronous liver metastases and/or adjacent organs) (advPNET group: 43 patients). RESULTS: The associated resections included 27 hepatectomies, 9 vascular resections, 12 colectomies, 10 gastrectomies, 4 nephrectomies, 4 adrenalectomies, and 3 duodenojejunal resections. R0 was achieved in 41 patients (95%) in the advPNET. The rates of T3-T4 (73 vs 16%; p < .0001) and N+ (35 vs 13%; p = .007) were higher in the advPNET group. Mortality (5 vs 2%) and major morbidity (21 vs 19%) rates were similar between the 2 groups. The 5-year overall survival (OS) of the series was 87% in the isoPNET group and 66% in the advPNET group (p = .006). Only patients with both locally advanced disease and liver metastases showed worse survival (p = .0003). The advPNET group developed recurrence earlier [disease-free survival (DFS) at 5 years: 26 vs 81%; p < .001]. In univariate analysis, negative prognostic factors of survival were: poor degree of differentiation (p < .001), liver metastasis (p = .011), NE carcinoma (p < .001), and resection of adjacent organs (p = .013). The multivariate analysis did not highlight any factor that influenced OS. In multivariate analysis independent DFS factors were a poor degree of differentiation (p = .03) and the European Neuroendocrine Tumor Society stage (p = .01). CONCLUSIONS: An aggressive surgical approach for locally advanced or metastatic tumors is safe and offers long-term survival.
Authors: Laura Prakash; Priya Bhosale; Jordan Cloyd; Michael Kim; Nathan Parker; James Yao; Arvind Dasari; Daniel Halperin; Thomas Aloia; Jeffrey E Lee; Jean Nicolas Vauthey; Jason B Fleming; Matthew H G Katz Journal: J Gastrointest Surg Date: 2016-09-15 Impact factor: 3.452
Authors: Alexander V Fisher; Alexandra G Lopez-Aguiar; Victoria R Rendell; Courtney Pokrzywa; Flavio G Rocha; Zaheer S Kanji; George A Poultsides; Eleftherios A Makris; Mary E Dillhoff; Eliza W Beal; Ryan C Fields; Roheena Z Panni; Kamran Idrees; Paula Marincola Smith; Clifford S Cho; Megan V Beems; Shishir K Maithel; Emily R Winslow; Daniel E Abbott; Sharon M Weber Journal: J Gastrointest Surg Date: 2019-01-18 Impact factor: 3.452
Authors: M Falconi; B Eriksson; G Kaltsas; D K Bartsch; J Capdevila; M Caplin; B Kos-Kudla; D Kwekkeboom; G Rindi; G Klöppel; N Reed; R Kianmanesh; R T Jensen Journal: Neuroendocrinology Date: 2016-01-05 Impact factor: 4.914
Authors: Jeffery Chakedis; Eliza W Beal; Alexandra G Lopez-Aguiar; George Poultsides; Eleftherios Makris; Flavio G Rocha; Zaheer Kanji; Sharon Weber; Alexander Fisher; Ryan Fields; Bradley A Krasnick; Kamran Idrees; Paula Marincola-Smith; Clifford Cho; Megan Beems; Timothy M Pawlik; Shishir K Maithel; Carl R Schmidt; Mary Dillhoff Journal: J Gastrointest Surg Date: 2018-10-17 Impact factor: 3.452