Chronological improvement of pancreatectomy for resectable but advanced pancreatic neuroendocrine neoplasms |
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| Affiliation: | 1. Department of Radiology, Cincinnati Children''s Hospital Medical Center, Cincinnati, OH, USA;2. Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA;3. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA;4. Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children''s Hospital Medical Center, Cincinnati, OH, USA;5. Division of Endocrinology, Cincinnati Children''s Hospital Medical Center, Cincinnati, OH, USA;6. Division of Pediatric General and Thoracic Surgery, Cincinnati Children''s Hospital Medical Center, Cincinnati, OH, USA;1. Division of Gastroenterology, Department of Internal Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA;2. Department of Internal Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA;3. Division of Gastroenterology, Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA;1. Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary;2. Szentágothai Research Centre, University of Pécs, Pécs, Hungary;3. Heim Pál National Institute of Pediatrics, Budapest, Hungary;4. Centre for Translational Medicine, Semmelweis University, Budapest, Hungary;5. Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary;6. Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Hungary;1. Department of Epidemiology, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA;2. Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, USA;3. Department of Laboratory Medicine and Pathology, School of Medicine, University of Minnesota, Minneapolis, MN, USA;4. Department of Surgery, Baylor College of Medicine, Houston, TX, USA;5. Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA;6. Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA;1. Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA;2. Division of Gastroenterology, Hepatology & Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA;3. Division of Gastroenterology, Brigham & Women''s Hospital, Boston, MA, USA;4. Mercy Clinic Gastroenterology, St. Louis, MO, USA;5. Division of Gastroenterology & Hepatology, Mayo Clinic, Phoenix, AZ, USA;6. Division of OneGI, Tupelo, MS, USA;7. Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA;8. Division of Gastroenterology, Oregon Health Science University, Portland, OR, USA;9. Division of Gastroenterology & Hepatology, Dartmouth-Hitchcock Medical Center, Hanover, NH, USA;10. GastroHealth, Miami, FL, USA;11. Aurora St. Luke''s Medical Center, Milwaukee, WI, USA;12. Division of Gastroenterology, Hepatology & Nutrition, University of Florida, Gainesville, FL, USA;13. Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, FL, USA;14. Division of Gastroenterology & Hepatology, Indiana University, Indianapolis, IN, USA;15. Digestive Diseases, Yale University, New Haven, CT, USA;p. Palmetto Health, Columbia Gastroenterology Associates, Columbia, SC, USA;q. Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA;r. Gastroenterology Associates, Richmond, VA, USA;s. Division of Gastroenterology & Hepatology, University of Alabama, Birmingham, AL, USA |
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| Abstract: | BackgroundProgress of non-surgical treatments in the last decade has improved the prognosis of pancreatic neuroendocrine neoplasms (PanNEN). However, the improvement of surgery for advanced PanNEN remains unknown. This study aimed to investigate the chronological changes of the clinical impact of pancreatectomy for PanNEN.MethodsPatients undergoing curative-intent pancreatectomy for PanNEN between 1991 and 2010 were categorized into the earlier period group, and those between 2011 and 2021 were into the later period group.Advanced PanNEN was defined as showing resectable synchronous liver metastases or invasion to portal venous systems or adjacent organs. The recurrence-free survival (RFS) and overall survival (OS) were analyzed among patients with non-advanced and advanced PanNENs. The independent prognostic risk factors were identified using a Cox proportional hazard model.ResultsA total of 189 patients (n = 54 in the earlier period and n = 135 in the later period) were included. The proportion of advanced PanNEN increased from 15% to 30% (P = 0.027). The RFS and OS of non-advanced PanNEN were similar between the periods. Whereas, among patients with advanced PanNEN, the later period group showed improved prognosis; The 5-year RFS of the earlier period vs. the later period was 0% vs. 27%, and the 5-year OS was 38% vs. 82% (p = 0.013).ConclusionsA radical surgical treatment for advanced PanNEN has shown prognostic improvement in this decade. However, more careful perioperative examinations and possibly, additional treatments are required for PanNEN with portal vein invasion. |
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| Keywords: | Pancreatic neuroendocrine tumor Pancreatectomy Portal vein invasion Portal vein tumor thrombus Chronological changes |
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