Ville J Sallinen1, Tessa Y S Le Large2, Elke Tieftrunk3, Shamil Galeev4, Zahar Kovalenko5, Sven-Petter Haugvik6, Anne Antila7, Oskar Franklin8, Emma Martinez-Moneo9, Stuart M Robinson10, Francesco Panzuto11, Nicolas Regenet12, Francesca Muffatti13, Stefano Partelli13, Dominik Wiese14, Philippe Ruszniewski15, Bertrand Dousset16, Bjørn Edwin17, Detlef K Bartsch14, Alain Sauvanet18, Massimo Falconi13, Güralp O Ceyhan3, Sebastien Gaujoux16. 1. Department of Abdominal Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; Department of Transplantation and Liver Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland. Electronic address: ville.salinen@helsinki.fi. 2. Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands. 3. Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany. 4. General Surgery Department, Saint Luke's Clinical Hospital, Saint Petersburg, Russia. 5. Federal Medical and Rehabilitation Center, Department of Surgical Oncology, Moscow, Russia. 6. The Intervention Center, Oslo University Hospital, Oslo, Norway; Department of Surgery, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway. 7. Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland. 8. Department of Surgical and Perioperative Sciences, Umea University, Umea, Sweden. 9. Gastroenterology Department, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain. 10. Department of HPB Surgery, Freeman Hospital, Newcastle Upon Tyne, UK. 11. Digestive and Liver Disease Unit, Sant'Andrea Hospital - Sapienza University of Rome, Italy. 12. Department of Digestive and Endocrine Surgery, Institut des Maladies Digestives (IMAD), Nantes 44093, France. 13. Chirurgia Del Pancreas, Chirurgia Del Pancreas, Pancreas Translational & Clinical Research Center, Università Vita e Salute, Ospedale San Raffaele IRCC, Milano, Italy. 14. Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Marburg, Germany. 15. Department of Gastroenterology, Pôle des Maladies de L'Appareil Digestif (PMAD), DHU Unity, Clichy 92110, France; Université Paris Diderot, Paris, France. 16. Department of Digestive, Pancreatic and Endocrine Surgery, Cochin Hospital, APHP, Paris, France; Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. 17. The Intervention Center, Oslo University Hospital, Oslo, Norway; Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 18. Université Paris Diderot, Paris, France; AP-HP, Hôpital Beaujon, Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de L'Appareil Digestif (PMAD), DHU Unity, University Paris VII, AP-HP, Hôpital Beaujon, Clichy 92110, France.
Abstract
BACKGROUND: Malignant potential of small (≤20 mm) nonfunctional pancreatic neuroendocrine tumors (sNF-PNET) is difficult to predict and management remain controversial. The aim of this study was to assess the prognosis of sporadic nonmetastatic sNF-PNETs. METHODS: Patients were identified from databases of 16 centers. Outcomes and risk factors for recurrence were identified by uni- and multivariate analyses. RESULTS: sNF-PNET was resected in 210 patients, and 66% (n = 138) were asymptomatic. Median age was 60 years, median tumor size was 15 mm, parenchyma-sparing surgery was performed in 42%. Postoperative mortality was 0.5% (n = 1), severe morbidity rate was 14.3% (n = 30), and 14 of 132 patients (10.6%) with harvested lymph nodes had metastatic lymph nodes. Tumor size, presence of biliary or pancreatic duct dilatation, and WHO grade 2-3 were independently associated with recurrence. Patients with tumors sized ≤10 mm were disease free at last follow-up. The 1-, 3- and 5-year disease-free survival rates for patients with tumors sized 11-20 mm on preoperative imaging were 95.1%, 91.0%, and 87.3%, respectively. CONCLUSIONS: In sNF-PNETs, the presence of biliary or pancreatic duct dilatation or WHO grade 2-3 advocate for surgical treatment. In the remaining patients, a wait-and-see policy might be considered.
BACKGROUND: Malignant potential of small (≤20 mm) nonfunctional pancreatic neuroendocrine tumors (sNF-PNET) is difficult to predict and management remain controversial. The aim of this study was to assess the prognosis of sporadic nonmetastatic sNF-PNETs. METHODS:Patients were identified from databases of 16 centers. Outcomes and risk factors for recurrence were identified by uni- and multivariate analyses. RESULTS: sNF-PNET was resected in 210 patients, and 66% (n = 138) were asymptomatic. Median age was 60 years, median tumor size was 15 mm, parenchyma-sparing surgery was performed in 42%. Postoperative mortality was 0.5% (n = 1), severe morbidity rate was 14.3% (n = 30), and 14 of 132 patients (10.6%) with harvested lymph nodes had metastatic lymph nodes. Tumor size, presence of biliary or pancreatic duct dilatation, and WHO grade 2-3 were independently associated with recurrence. Patients with tumors sized ≤10 mm were disease free at last follow-up. The 1-, 3- and 5-year disease-free survival rates for patients with tumors sized 11-20 mm on preoperative imaging were 95.1%, 91.0%, and 87.3%, respectively. CONCLUSIONS: In sNF-PNETs, the presence of biliary or pancreatic duct dilatation or WHO grade 2-3 advocate for surgical treatment. In the remaining patients, a wait-and-see policy might be considered.
Authors: James R Howe; Nipun B Merchant; Claudius Conrad; Xavier M Keutgen; Julie Hallet; Jeffrey A Drebin; Rebecca M Minter; Terry C Lairmore; Jennifer F Tseng; Herbert J Zeh; Steven K Libutti; Gagandeep Singh; Jeffrey E Lee; Thomas A Hope; Michelle K Kim; Yusuf Menda; Thorvardur R Halfdanarson; Jennifer A Chan; Rodney F Pommier Journal: Pancreas Date: 2020-01 Impact factor: 3.327
Authors: Xavier M Keutgen; Kimberly J Ornell; Alyx Vogle; Olga Lakiza; Jelani Williams; Paul Miller; Katelyn S Mistretta; Namrata Setia; Ralph R Weichselbaum; Jeannine M Coburn Journal: Ann Surg Oncol Date: 2021-06-05 Impact factor: 5.344
Authors: Michael Goggins; Kasper Alexander Overbeek; Randall Brand; Sapna Syngal; Marco Del Chiaro; Detlef K Bartsch; Claudio Bassi; Alfredo Carrato; James Farrell; Elliot K Fishman; Paul Fockens; Thomas M Gress; Jeanin E van Hooft; R H Hruban; Fay Kastrinos; Allison Klein; Anne Marie Lennon; Aimee Lucas; Walter Park; Anil Rustgi; Diane Simeone; Elena Stoffel; Hans F A Vasen; Djuna L Cahen; Marcia Irene Canto; Marco Bruno Journal: Gut Date: 2019-10-31 Impact factor: 23.059