TY - JOUR
T1 - The Evolution of Surgical Strategies for Pancreatic Neuroendocrine Tumors (Pan-NENs)
T2 - Time-trend and Outcome Analysis From 587 Consecutive Resections at a High-volume Institution
AU - Landoni, Luca
AU - Marchegiani, Giovanni
AU - Pollini, Tommaso
AU - Cingarlini, Sara
AU - D'Onofrio, Mirko
AU - Capelli, Paola
AU - De Robertis, Riccardo
AU - Davì, Maria V.
AU - Amodio, Antonio
AU - Impellizzeri, Harmony
AU - Malpaga, Anna
AU - Miotto, Marco
AU - Boninsegna, Letizia
AU - Crepaz, Lorenzo
AU - Nessi, Chiara
AU - Zingaretti, Caterina C.
AU - Paiella, Salvatore
AU - Esposito, Alessandro
AU - Casetti, Luca
AU - Malleo, Giuseppe
AU - Tuveri, Massimiliano
AU - Butturini, Giovanni
AU - Salvia, Roberto
AU - Scarpa, Aldo
AU - Falconi, Massimo
AU - Bassi, Claudio
PY - 2019/4/1
Y1 - 2019/4/1
N2 - OBJECTIVE: The objective of the present analysis is 2-fold: first, to define the evolution of time trends on the surgical approach to pancreatic neuroendocrine neoplasms (Pan-NENs); second, to perform a complete analysis of the predictors of oncologic outcome. BACKGROUND: Reflecting their rarity and heterogeneity, Pan-NENs represent a clinical dilemma. In particular, there is a scarcity of data regarding their long-term follow-up after surgical resection. METHODS: From the Institutional Pan-NEN database, 587 resected cases from 1990 to 2015 were extracted. The time span was arbitrarily divided into 3 discrete clusters enabling a balanced comparison between patient groups. Analyses for predictors of recurrence and survival were performed, together with conditional survival analyses. RESULTS: Among the 587 resected Pan-NENs, 75% were nonfunctioning tumors, and 5% were syndrome-associated tumors. The mean age was 54 years (±14 years), and 51% of the patients were female. The median tumor size was 20 mm (range 4 to 140), 62% were G1, 32% were G2, and 4% were G3 tumors. Time trends analysis revealed that the number of resected Pan-NENs constantly increased, while the size (from 25 to 20 mm) and G1 proportion (from 65% to 49%) decreased during the study period. After a mean follow-up of 75 months, recurrence analysis revealed that nonfunctioning tumors, tumor grade, N1 status, and vascular invasion were all independent predictors of recurrence. Regardless of size, G1 nonfunctioning tumors with no nodal involvement and vascular invasion had a negligible risk of recurrence at 5 years. CONCLUSIONS: Pan-NENs have been increasingly diagnosed and resected during the last 3 decades, revealing reliable predictors of outcome. Functioning and nodal status, tumor grade, and vascular invasion accurately predict survival and recurrence with resulting implications for patient follow-up.
AB - OBJECTIVE: The objective of the present analysis is 2-fold: first, to define the evolution of time trends on the surgical approach to pancreatic neuroendocrine neoplasms (Pan-NENs); second, to perform a complete analysis of the predictors of oncologic outcome. BACKGROUND: Reflecting their rarity and heterogeneity, Pan-NENs represent a clinical dilemma. In particular, there is a scarcity of data regarding their long-term follow-up after surgical resection. METHODS: From the Institutional Pan-NEN database, 587 resected cases from 1990 to 2015 were extracted. The time span was arbitrarily divided into 3 discrete clusters enabling a balanced comparison between patient groups. Analyses for predictors of recurrence and survival were performed, together with conditional survival analyses. RESULTS: Among the 587 resected Pan-NENs, 75% were nonfunctioning tumors, and 5% were syndrome-associated tumors. The mean age was 54 years (±14 years), and 51% of the patients were female. The median tumor size was 20 mm (range 4 to 140), 62% were G1, 32% were G2, and 4% were G3 tumors. Time trends analysis revealed that the number of resected Pan-NENs constantly increased, while the size (from 25 to 20 mm) and G1 proportion (from 65% to 49%) decreased during the study period. After a mean follow-up of 75 months, recurrence analysis revealed that nonfunctioning tumors, tumor grade, N1 status, and vascular invasion were all independent predictors of recurrence. Regardless of size, G1 nonfunctioning tumors with no nodal involvement and vascular invasion had a negligible risk of recurrence at 5 years. CONCLUSIONS: Pan-NENs have been increasingly diagnosed and resected during the last 3 decades, revealing reliable predictors of outcome. Functioning and nodal status, tumor grade, and vascular invasion accurately predict survival and recurrence with resulting implications for patient follow-up.
UR - http://www.scopus.com/inward/record.url?scp=85062592467&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85062592467&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000002594
DO - 10.1097/SLA.0000000000002594
M3 - Article
C2 - 29189384
VL - 269
SP - 725
EP - 732
JO - Annals of Surgery
JF - Annals of Surgery
SN - 0003-4932
IS - 4
ER -