Exploring the surgical landscape of pancreatic neuroendocrine neoplasia in Austria: Results from the ASSO pNEN study group |
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| Affiliation: | 1. Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria;2. Department of Surgery, Paracelsus Medical University, Salzburg, Austria;3. Institute of Pathology, Paracelsus Medical University, Salzburg, 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;1. Department of Surgery Oncology and Gastroenterology (DISCOG), University of Padua, Italy;2. Surgical Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy;3. Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia;4. Cork Cancer Research Centre, Cork, Ireland;5. Oncologic Gynecology Unit, Sant''Orsola-Malpighi Hospital, Bologna, Italy;6. 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy;7. Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia;8. Christie NHS Foundation Trust, CRUK Manchester Institute, The University of Manchester, Manchester, M20 4GJ, UK;9. University of Ljubljana, Faculty of Electrical Engineering, Ljubljana, Slovenia;10. Department of Industrial Engineering, University of Padua, Italy;1. Department of Pancreatic Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, China;2. Department of Plastic & Reconstructive Surgery, Shanghai Ninth People''s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China;1. Department of Surgery, Rabin Medical Center, Petah Tikva, Israel;2. The Sackler School of Medicine, Tel-Aviv University, Israel;3. Department of Nuclear Medicine, Rabin Medical Center, Petah Tikva, Israel;1. Division of Surgical Oncology, Radboud University Medical Centre, Geert Groteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands;2. Division of Research, Netherlands Comprehensive Cancer Organization (IKNL), Postbus 19079, 3501 DB, Utrecht, the Netherlands;3. Division of Public Health, Erasmus MC University Medical Centre, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands;4. Division of Surgery, Catharina Hospital, Postbus 1350, 5602 ZA, Eindhoven, the Netherlands;5. Division of Surgery, Elisabeth – TweeSteden Hospital, Doctor Deelenlaan 5, 5042 AD, Tilburg, the Netherlands |
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| Abstract: | IntroductionPancreatic 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.MethodsRetrospective, national cohort-study from 7 medium-/high-volume centres in Austria, coordinated under the auspices of the Austrian Society of Surgical Oncology (ASSO).ResultsTwo-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.ConclusionResection 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. |
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| Keywords: | Pancreatic neuroendocrine tumours Pancreatic neuroendocrine neoplasia Survival Pancreas Resection Surgery AJCC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0045" }," $$" :[{" #name" :" text" ," _" :" American Joint Committee on Cancer ASS0" },{" #name" :" keyword" ," $" :{" id" :" kwrd0055" }," $$" :[{" #name" :" text" ," _" :" Austrian Society of Surgical Oncology CI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0065" }," $$" :[{" #name" :" text" ," _" :" Confidence interval ENETS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0075" }," $$" :[{" #name" :" text" ," _" :" European Neuroendocrine Tumour Society HR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0085" }," $$" :[{" #name" :" text" ," _" :" Hazards ratio MEN" },{" #name" :" keyword" ," $" :{" id" :" kwrd0095" }," $$" :[{" #name" :" text" ," _" :" Multiple endocrine neoplasia NEC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0105" }," $$" :[{" #name" :" text" ," _" :" Neuroendocrine carcinoma NET" },{" #name" :" keyword" ," $" :{" id" :" kwrd0115" }," $$" :[{" #name" :" text" ," _" :" Neuroendocrine tumour OS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0125" }," $$" :[{" #name" :" text" ," _" :" Overall survival ISGPF" },{" #name" :" keyword" ," $" :{" id" :" kwrd0135" }," $$" :[{" #name" :" text" ," _" :" International study group of pancreatic fistula PDAC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0145" }," $$" :[{" #name" :" text" ," _" :" pancreatic ductal adenocarcinoma pNEN" },{" #name" :" keyword" ," $" :{" id" :" kwrd0155" }," $$" :[{" #name" :" text" ," _" :" pancreatic neuroendocrine neoplasia PRRT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0165" }," $$" :[{" #name" :" text" ," _" :" Peptide receptor radionuclide therapy RFS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0175" }," $$" :[{" #name" :" text" ," _" :" Recurrence free survival SD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0185" }," $$" :[{" #name" :" text" ," _" :" Standard deviation SSA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0195" }," $$" :[{" #name" :" text" ," _" :" Somatostatin analogs WHO" },{" #name" :" keyword" ," $" :{" id" :" kwrd0205" }," $$" :[{" #name" :" text" ," _" :" World Health Organization |
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