Florian Primavesi1, Eckhard Klieser2, Benno Cardini3, Katharina Marsoner4, Uwe Fröschl5, Sabine Thalhammer6, Ines Fischer7, Andreas Hauer8, Romana Urbas2, Tobias Kiesslich9, Daniel Neureiter2, Matthias Zitt10, Reinhold Klug8, Helwig Wundsam7, Franz Sellner6, Josef Karner6, Reinhold Függer5, Fergül Cakar-Beck3, Peter Kornprat4, Dietmar Öfner3, Stefan Stättner11. 1. Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria; Department of Surgery, Paracelsus Medical University, Salzburg, Austria. 2. Institute of Pathology, Paracelsus Medical University, Salzburg, Austria. 3. Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria. 4. Department of Surgery, Medical University Graz, Graz, Austria. 5. Department of Surgery, Elisabethinen Hospital, Linz, Austria. 6. Department of Surgery, Kaiser Franz Josef Hospital, Vienna, Austria. 7. Department of Surgery, Hospital Sisters of Mercy Linz, Linz, Austria. 8. Department of Surgery, General Hospital Horn, Horn, Austria. 9. Department of Internal Medicine I, Paracelsus Medical University, Salzburg, Austria. 10. Department of Surgery, General Hospital Dornbirn, Dornbirn, Austria. 11. Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria. Electronic address: stefan.staettner@i-med.ac.at.
Abstract
INTRODUCTION: Pancreatic neuroendocrine neoplasia (pNEN) show increasing incidence and management is complex due to biological heterogeneity. Most publications report isolated high-volume single-centre data. This Austrian multi-centre study on surgical management of pNENs provides a comprehensive real-life picture of quality indicators, recurrence-patterns, survival factors and systemic treatments. METHODS: Retrospective, national cohort-study from 7 medium-/high-volume centres in Austria, coordinated under the auspices of the Austrian Society of Surgical Oncology (ASSO). RESULTS: Two-hundred patients underwent resection for pNEN, 177 had non-functioning tumours and 31 showed stage 4 disease. Participating centres were responsible for 2/3 of pNEN resections in Austria within the last years. The mean rate of completeness of variables was 98.6%. Ninety-days mortality was 3.5%, overall rate of complications was 42.5%. Morbidity did not influence long-term survival. The 5-year overall-survival (OS) was 81.3%, 10-year-OS 52.5% and 5-year recurrence-free-survival (RFS) 69.8%. Recurrence was most common in the liver (68.1%). Four out of five patients with recurrence underwent further treatment, most commonly with medical therapy or chemotherapy. Multivariable analysis revealed grading (HR:2.7) and metastasis (HR:2.5) as significant factors for relapse. Tumours-size ≥2 cm (HR:5.9), age ≥60 years (HR:3.1), metastasis (HR:2.3) and grading (HR:2.0) were associated with OS. Tumours <2 cm showed 93.9% 10-year-OS, but 33% had G2/G3 grading, 12.5% positive lymph-nodes and 4.7% metastasis at diagnosis, each associated with significant worse survival. CONCLUSION: Resection of pNENs in Austria is performed with internationally comparable safety. Analysed factors allow for risk-stratification in clinical treatment and future prospective trials. A watch-and-wait strategy purely based on tumour-size cannot be recommended.
INTRODUCTION:Pancreatic neuroendocrine neoplasia (pNEN) show increasing incidence and management is complex due to biological heterogeneity. Most publications report isolated high-volume single-centre data. This Austrian multi-centre study on surgical management of pNENs provides a comprehensive real-life picture of quality indicators, recurrence-patterns, survival factors and systemic treatments. METHODS: Retrospective, national cohort-study from 7 medium-/high-volume centres in Austria, coordinated under the auspices of the Austrian Society of Surgical Oncology (ASSO). RESULTS: Two-hundred patients underwent resection for pNEN, 177 had non-functioning tumours and 31 showed stage 4 disease. Participating centres were responsible for 2/3 of pNEN resections in Austria within the last years. The mean rate of completeness of variables was 98.6%. Ninety-days mortality was 3.5%, overall rate of complications was 42.5%. Morbidity did not influence long-term survival. The 5-year overall-survival (OS) was 81.3%, 10-year-OS 52.5% and 5-year recurrence-free-survival (RFS) 69.8%. Recurrence was most common in the liver (68.1%). Four out of five patients with recurrence underwent further treatment, most commonly with medical therapy or chemotherapy. Multivariable analysis revealed grading (HR:2.7) and metastasis (HR:2.5) as significant factors for relapse. Tumours-size ≥2 cm (HR:5.9), age ≥60 years (HR:3.1), metastasis (HR:2.3) and grading (HR:2.0) were associated with OS. Tumours <2 cm showed 93.9% 10-year-OS, but 33% had G2/G3 grading, 12.5% positive lymph-nodes and 4.7% metastasis at diagnosis, each associated with significant worse survival. CONCLUSION: Resection of pNENs in Austria is performed with internationally comparable safety. Analysed factors allow for risk-stratification in clinical treatment and future prospective trials. A watch-and-wait strategy purely based on tumour-size cannot be recommended.
Authors: Masayuki Tanaka; Max Heckler; André L Mihaljevic; Pascal Probst; Ulla Klaiber; Ulrike Heger; Simon Schimmack; Markus W Büchler; Thilo Hackert Journal: Ann Surg Oncol Date: 2020-07-27 Impact factor: 5.344
Authors: Florian Primavesi; Valentina Andreasi; Frederik J H Hoogwater; Stefano Partelli; Dominik Wiese; Charlotte Heidsma; Benno Cardini; Eckhard Klieser; Katharina Marsoner; Uwe Fröschl; Sabine Thalhammer; Ines Fischer; Georg Göbel; Andreas Hauer; Tobias Kiesslich; Philipp Ellmerer; Reinhold Klug; Daniel Neureiter; Helwig Wundsam; Franz Sellner; Peter Kornprat; Reinhold Függer; Dietmar Öfner; Elisabeth J M Nieveen van Dijkum; Detlef K Bartsch; Ruben H J de Kleine; Massimo Falconi; Stefan Stättner Journal: Cancers (Basel) Date: 2020-05-14 Impact factor: 6.639
Authors: Noémie S Minczeles; Casper H J van Eijck; Marjon J van Gils; Marie-Louise F van Velthuysen; Els J M Nieveen van Dijkum; Richard A Feelders; Wouter W de Herder; Tessa Brabander; Johannes Hofland Journal: Eur J Nucl Med Mol Imaging Date: 2022-03-01 Impact factor: 10.057