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Fei S, Wu WD, Zhang HS, Liu SJ, Li D, Jin B. Primary coexisting adenocarcinoma of the colon and neuroendocrine tumor of the duodenum: A case report and review of the literature. World J Gastrointest Surg 2024; 16:2724-2734. [PMID: 39220064 PMCID: PMC11362920 DOI: 10.4240/wjgs.v16.i8.2724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/13/2024] [Accepted: 06/07/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Neuroendocrine tumors (NETs) arise from the body's diffuse endocrine system. Coexisting primary adenocarcinoma of the colon and NETs of the duodenum (D-NETs) is a rare occurrence in clinical practice. The classification and treatment criteria for D-NETs combined with a second primary cancer have not yet been determined. CASE SUMMARY We report the details of a case involving female patient with coexisting primary adenocarcinoma of the colon and a D-NET diagnosed by imaging and surgical specimens. The tumors were treated by surgery and four courses of chemotherapy. The patient achieved a favorable clinical prognosis. CONCLUSION Coexisting primary adenocarcinoma of the colon and D-NET were diagnosed by imaging, laboratory indicators, and surgical specimens. Surgical resection combined with chemotherapy was a safe, clinically effective, and cost-effective treatment.
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Affiliation(s)
- Song Fei
- Department of Thoracic and Cardiovascular Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou 510000, Guangdong Province, China
| | - Wei-Dong Wu
- Department of Thoracic and Cardiovascular Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou 510000, Guangdong Province, China
| | - Han-Shuo Zhang
- Department of Gastrointestinal Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou 510000, Guangdong Province, China
| | - Shao-Jie Liu
- Department of Gastrointestinal Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou 510000, Guangdong Province, China
| | - Dan Li
- Department of Thoracic and Cardiovascular Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou 510000, Guangdong Province, China
| | - Bo Jin
- Department of Thoracic and Cardiovascular Surgery, Guangzhou Red Cross Hospital of Jinan University, Guangzhou 510000, Guangdong Province, China
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Shintakuya R, Uemura K, Sumiyoshi T, Okada K, Baba K, Harada T, Murakami Y, Serikawa M, Ishii Y, Arihiro K, Takahashi S. Optimal Lymphadenectomy in Patients with Well-Differentiated Nonfunctioning Pancreatic Neuroendocrine Neoplasms. J Clin Med 2023; 12:6778. [PMID: 37959242 PMCID: PMC10647402 DOI: 10.3390/jcm12216778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
This study aimed to evaluate the optimal extent of lymphadenectomy in patients with nonfunctioning pancreatic neuroendocrine neoplasms. We retrospectively analyzed the clinicopathological data of patients with nonfunctioning pancreatic neuroendocrine neoplasms who underwent surgical resection. We investigated the frequency of metastases at each lymph node station according to tumor location and analyzed the factors contributing to poor overall survival (OS) and disease-free survival (DFS). Overall, data of 84 patients were analyzed. Among patients with pancreatic head tumors, metastases at stations 8, 13, and 17 were found in one (3.1%), four (12.5%), and three (9.3%) patients, respectively. However, none of the other stations showed metastases. For pancreatic body and tail tumors, metastases only at station 11 were found in two (5.1%) patients. Additionally, multivariate DFS and OS analyses showed that lymph node metastasis was the only independent prognostic factor. In conclusion, lymph node metastasis near the primary tumor was the only independent factor of poor prognosis in patients with nonfunctioning pancreatic neuroendocrine neoplasms after undergoing curative surgery. Peri-pancreatic lymphadenectomy might be recommended for nonfunctioning pancreatic neuroendocrine neoplasms.
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Affiliation(s)
- Ryuta Shintakuya
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 739-8526, Japan
| | - Kenichiro Uemura
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 739-8526, Japan
| | - Tatsuaki Sumiyoshi
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 739-8526, Japan
| | - Kenjiro Okada
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 739-8526, Japan
| | - Kenta Baba
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 739-8526, Japan
| | - Takumi Harada
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 739-8526, Japan
| | - Yoshiaki Murakami
- Department of Advanced Medicine, Hiroshima University, Hiroshima 739-8526, Japan
| | - Masahiro Serikawa
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 739-8526, Japan
| | - Yasutaka Ishii
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 739-8526, Japan
| | - Koji Arihiro
- Department of Anatomical Pathology, Hiroshima University, Hiroshima 739-8526, Japan
| | - Shinya Takahashi
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 739-8526, Japan
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Abdalla TSA, Klinkhammer-Schalke M, Zeissig SR, Tol KKV, Honselmann KC, Braun R, Bolm L, Lapshyn H, Litkevych S, Zemskov S, Begum N, Kulemann B, Hummel R, Wellner UF, Keck T, Deichmann S. Prognostic factors after resection of locally advanced non-functional pancreatic neuroendocrine neoplasm: an analysis from the German Cancer Registry Group of the Society of German Tumor Centers. J Cancer Res Clin Oncol 2023; 149:8535-8543. [PMID: 37095413 PMCID: PMC10374814 DOI: 10.1007/s00432-023-04785-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/15/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVE The available literature regarding outcome after pancreatic resection in locally advanced non-functional pNEN (LA-pNEN) is sparse. Therefore, this study evaluates the current survival outcomes and prognostic factors in after resection of LA-pNEN. MATERIALS AND METHODS This population-based analysis was derived from 17 German cancer registries from 2000 to 2019. Patients with upfront resected non-functional non-metastatic LA-pNEN were included. RESULTS Out of 2776 patients with pNEN, 277 met the inclusion criteria. 137 (45%) of the patients were female. The median age was 63 ± 18 years. Lymph node metastasis was present in 45%. G1, G2 and G3 pNEN were found in 39%, 47% and 14% of the patients, respectively. Resection of LA-pNEN resulted in favorable 3-, 5- and 10-year overall survival of 79%, 74%, and 47%. Positive resection margin was the only potentially modifiable independent prognostic factor for overall survival (HR 1.93, 95% CI 1.71-3.69, p value = 0.046), whereas tumor grade G3 (HR 5.26, 95% CI 2.09-13.25, p value < 0.001) and lymphangiosis (HR 2.35, 95% CI 1.20-4.59, p value = 0.012) were the only independent prognostic factors for disease-free survival. CONCLUSION Resection of LA-pNEN is feasible and associated with favorable overall survival. G1 LA-pNEN with negative resection margins and absence of lymph node metastasis and lymphangiosis might be considered as cured, while those not fulfilling these criteria might be considered as a high-risk group for disease progression. Herein, negative resection margins represent the only potentially modifiable prognostic factor in LA-pNEN but seem to be influenced by tumor grade.
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Affiliation(s)
- Thaer S A Abdalla
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23564, Lübeck, Germany.
| | - Monika Klinkhammer-Schalke
- Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, Berlin, Germany
| | - Sylke Ruth Zeissig
- Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, Berlin, Germany
- Institute of Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Würzburg, Germany
| | - Kees Kleihues-van Tol
- Network for Care, Quality and Research in Oncology (ADT), German Cancer Registry Group of the Society of German Tumor Centers, Berlin, Germany
| | - Kim C Honselmann
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23564, Lübeck, Germany
| | - Rüdiger Braun
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23564, Lübeck, Germany
| | - Louisa Bolm
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23564, Lübeck, Germany
| | - Hryhoriy Lapshyn
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23564, Lübeck, Germany
| | - Stanislav Litkevych
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23564, Lübeck, Germany
| | - Sergii Zemskov
- Department of General Surgery, Bogomolets National Medical University, Kiev, 01601, Ukraine
| | - Nehara Begum
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23564, Lübeck, Germany
- Department of Surgery, Johannes-Wesling-Klinikum Minden, Minden, Germany
| | - Birte Kulemann
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23564, Lübeck, Germany
| | - Richard Hummel
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23564, Lübeck, Germany
| | - Ulrich Friedrich Wellner
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23564, Lübeck, Germany
| | - Tobias Keck
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23564, Lübeck, Germany.
| | - Steffen Deichmann
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23564, Lübeck, Germany
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Tuncer A, Ogut Z, Usta S, Akbulut S, Sahin TT, Yilmaz S. Concomittant Liver Transplantation and Low Anterior Resection in Patient with Neuroendocrine Tumor and Chronic Hepatitis B Infection. J Gastrointest Cancer 2022; 53:1121-1123. [PMID: 34611835 PMCID: PMC8492089 DOI: 10.1007/s12029-021-00719-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Adem Tuncer
- Liver Transplant Institute and Department of Surgery , Faculty of Medicine, Inonu University, 44280, Malatya, Turkey.
| | - Zeki Ogut
- Liver Transplant Institute and Department of Surgery , Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Sertac Usta
- Liver Transplant Institute and Department of Surgery , Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Sami Akbulut
- Liver Transplant Institute and Department of Surgery , Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Tevfik Tolga Sahin
- Liver Transplant Institute and Department of Surgery , Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
| | - Sezai Yilmaz
- Liver Transplant Institute and Department of Surgery , Faculty of Medicine, Inonu University, 44280, Malatya, Turkey
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Baz C, Dreifuss NH, Cubisino A, Schlottmann F, Mangano A, Aguiluz G, Vanetta C, Masrur MA, Giulianotti PC. May the robotic approach expand the indications for redo surgery in recurrent pNETs in Multiple Neuroendocrine Neoplasia type 1? J Surg Case Rep 2022; 2022:rjac433. [PMID: 36158249 PMCID: PMC9491866 DOI: 10.1093/jscr/rjac433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/29/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Pancreatic neuroendocrine tumors (pNETs) represent the leading cause of disease-specific mortality in patients with Multiple Neuroendocrine Neoplasia type 1 (MEN1). Although surgery is the recommended treatment for non-functional pNETs >2 cm, the management of recurrent lesions between 1 and 2 cm is controversial. Robotic surgery was used on a 29-year-old female with MEN1 and previous distal splenopancreatectomy that presented with a 1 cm recurrent pNET. The advantages offered by this approach facilitating a precise resection of the tumor and minimizing the postoperative morbidity may favor the decision towards redo surgery for local recurrences <2 cm, expanding current indications.
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Affiliation(s)
- Carolina Baz
- Division of General , Minimally Invasive and Robotic Surgery, Department of Surgery, , Chicago, IL , USA
- University of Illinois at Chicago , Minimally Invasive and Robotic Surgery, Department of Surgery, , Chicago, IL , USA
| | - Nicolas H Dreifuss
- Division of General , Minimally Invasive and Robotic Surgery, Department of Surgery, , Chicago, IL , USA
- University of Illinois at Chicago , Minimally Invasive and Robotic Surgery, Department of Surgery, , Chicago, IL , USA
| | - Antonio Cubisino
- Division of General , Minimally Invasive and Robotic Surgery, Department of Surgery, , Chicago, IL , USA
- University of Illinois at Chicago , Minimally Invasive and Robotic Surgery, Department of Surgery, , Chicago, IL , USA
| | - Francisco Schlottmann
- Division of General , Minimally Invasive and Robotic Surgery, Department of Surgery, , Chicago, IL , USA
- University of Illinois at Chicago , Minimally Invasive and Robotic Surgery, Department of Surgery, , Chicago, IL , USA
| | - Alberto Mangano
- Division of General , Minimally Invasive and Robotic Surgery, Department of Surgery, , Chicago, IL , USA
- University of Illinois at Chicago , Minimally Invasive and Robotic Surgery, Department of Surgery, , Chicago, IL , USA
| | - Gabriela Aguiluz
- Division of General , Minimally Invasive and Robotic Surgery, Department of Surgery, , Chicago, IL , USA
- University of Illinois at Chicago , Minimally Invasive and Robotic Surgery, Department of Surgery, , Chicago, IL , USA
| | - Carolina Vanetta
- Division of General , Minimally Invasive and Robotic Surgery, Department of Surgery, , Chicago, IL , USA
- University of Illinois at Chicago , Minimally Invasive and Robotic Surgery, Department of Surgery, , Chicago, IL , USA
| | - Mario A Masrur
- Division of General , Minimally Invasive and Robotic Surgery, Department of Surgery, , Chicago, IL , USA
- University of Illinois at Chicago , Minimally Invasive and Robotic Surgery, Department of Surgery, , Chicago, IL , USA
| | - Pier Cristoforo Giulianotti
- Division of General , Minimally Invasive and Robotic Surgery, Department of Surgery, , Chicago, IL , USA
- University of Illinois at Chicago , Minimally Invasive and Robotic Surgery, Department of Surgery, , Chicago, IL , USA
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Li AY, Visser BC, Dua MM. Surgical Indications and Outcomes of Resection for Pancreatic Neuroendocrine Tumors with Vascular Involvement. Cancers (Basel) 2022; 14:cancers14092312. [PMID: 35565442 PMCID: PMC9103421 DOI: 10.3390/cancers14092312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 11/22/2022] Open
Abstract
Simple Summary Pancreatic neuroendocrine tumors (pNETs) are a heterogenous group of rare epithelial neoplasms. For most patients, surgery remains the only treatment modality to cure pNETs, and is recommended for patients with surgically resectable disease. Many of these tumors are non-functional tumors and do not produce clinical symptoms, so patients may present with locally advanced tumors, which invade surrounding organs or neighboring blood vessels. The presence of vascular involvement had previously been considered a contraindication to surgery, but, in recent years, at centers with considerable experience, aggressive surgery to remove pNETs with vascular reconstruction has been performed safely and with good long-term survival. In this review, we will discuss the considerations for resectability, review novel surgical approaches, and present the available evidence on the immediate and long-term postoperative outcomes. Abstract Complete surgical resection of pancreatic neuroendocrine tumors (pNETs) has been suggested as the only potentially curative treatment. A proportion of these tumors will present late during disease progression, and invade or encase surrounding vasculature; therefore, surgical treatment of locally advanced disease remains controversial. The role of surgery with vascular reconstruction in pNETs is not well defined, and there is considerable variability in the use of aggressive surgery for these tumors. Accurate preoperative assessment is critical to evaluate individual considerations, such as anatomical variants, areas and lengths of vessel involvement, proximal and distal targets, and collateralization secondary to the degree of occlusion. Surgical approaches to address pNETs with venous involvement may include thrombectomy, traditional vein reconstruction, a reconstruction-first approach, or mesocaval shunting. Although the amount of literature on pNETs with vascular reconstruction is limited to case reports and small institutional series, the last two decades of studies have demonstrated that aggressive resection of these tumors can be performed safely and with acceptable long-term survival.
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Martín Bellido V, Monticelli P, Vettorato E. Anaesthetic management of a cat with diabetes mellitus undergoing glucagonoma excision. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Marchese U, Gaillard M, Pellat A, Tzedakis S, Abou Ali E, Dohan A, Barat M, Soyer P, Fuks D, Coriat R. Multimodal Management of Grade 1 and 2 Pancreatic Neuroendocrine Tumors. Cancers (Basel) 2022; 14:433. [PMID: 35053593 PMCID: PMC8773540 DOI: 10.3390/cancers14020433] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 12/13/2022] Open
Abstract
Pancreatic neuroendocrine tumors (p-NETs) are rare tumors with a recent growing incidence. In the 2017 WHO classification, p-NETs are classified into well-differentiated (i.e., p-NETs grade 1 to 3) and poorly differentiated neuroendocrine carcinomas (i.e., p-NECs). P-NETs G1 and G2 are often non-functioning tumors, of which the prognosis depends on the metastatic status. In the localized setting, p-NETs should be surgically managed, as no benefit for adjuvant chemotherapy has been demonstrated. Parenchymal sparing resection, including both duodenum and pancreas, are safe procedures in selected patients with reduced endocrine and exocrine long-term dysfunction. When the p-NET is benign or borderline malignant, this surgical option is associated with low rates of severe postoperative morbidity and in-hospital mortality. This narrative review offers comments, tips, and tricks from reviewing the available literature on these different options in order to clarify their indications. We also sum up the overall current data on p-NETs G1 and G2 management.
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Affiliation(s)
- Ugo Marchese
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (M.G.); (S.T.); (D.F.)
| | - Martin Gaillard
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (M.G.); (S.T.); (D.F.)
| | - Anna Pellat
- Gastroenterology and Digestive Oncology Unit, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.P.); (E.A.A.); (R.C.)
| | - Stylianos Tzedakis
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (M.G.); (S.T.); (D.F.)
| | - Einas Abou Ali
- Gastroenterology and Digestive Oncology Unit, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.P.); (E.A.A.); (R.C.)
| | - Anthony Dohan
- Department of Radiology, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.D.); (M.B.); (P.S.)
| | - Maxime Barat
- Department of Radiology, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.D.); (M.B.); (P.S.)
| | - Philippe Soyer
- Department of Radiology, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.D.); (M.B.); (P.S.)
| | - David Fuks
- Department of Digestive, Hepatobiliary and Pancreatic Surgery, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (M.G.); (S.T.); (D.F.)
| | - Romain Coriat
- Gastroenterology and Digestive Oncology Unit, Cochin Teaching Hospital, AP-HP, Université de Paris, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France; (A.P.); (E.A.A.); (R.C.)
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Lindner K, Binte D, Hoeppner J, Wellner UF, Schulte DM, Schmid SM, Luley K, Buchmann I, Tharun L, Keck T, Gebauer J, Kulemann B. Resection of Non-Functional Pancreatic Neuroendocrine Neoplasms-A Single-Center Retrospective Outcome Analysis. ACTA ACUST UNITED AC 2021; 28:3071-3080. [PMID: 34436034 PMCID: PMC8395435 DOI: 10.3390/curroncol28040268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/07/2021] [Accepted: 08/08/2021] [Indexed: 01/08/2023]
Abstract
Surgery remains the only curative treatment of pancreatic neuroendocrine neoplasms (pNEN). Here, we report the outcome after surgery for non-functional pNEN at a European Neuroendocrine Tumor Society (ENETS) center in Germany between 2000 and 2019; cases were analyzed for surgical (Clavien–Dindo classification; CDc) and oncological outcomes. Forty-nine patients (tumor grading G1 n = 25, G2 n = 22, G3 n = 2), with a median age of 56 years, were included. Severe complications (CDc ≥ grade 3b) occurred in 11 patients (22.4%) and type B/C pancreatic fistulas (POPFs) occurred in 5 patients (10.2%); in-hospital mortality was 2% (n = 1). Six of seven patients with tumor recurrence (14.3%) had G2 tumors in the pancreatic body/tail. The median survival was 5.7 years (68 months; [1–228 months]). Neither the occurrence (p = 0.683) nor the severity of complications had an influence on the relapse behavior (p = 0.086). This also applied for a POPF (≥B, p = 0.609). G2 pNEN patients (n = 22) with and without tumor recurrence had similar median tumor sizes (4 cm and 3.9 cm, respectively). Five of the six relapsed G2 patients (83.3%) had tumor-positive lymph nodes (N+); all G2 pNEN patients with recurrence had initially been treated with distal pancreatic resection. Pancreatic resections for pNEN are safe but associated with relevant postoperative morbidity. Future studies are needed to evaluate suitable resection strategies for G2 pNEN.
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Affiliation(s)
- Kirsten Lindner
- Department of Surgery, University Medical Center of Schleswig-Holstein-Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; (K.L.); (D.B.); (J.H.); (U.F.W.); (T.K.)
| | - Daniel Binte
- Department of Surgery, University Medical Center of Schleswig-Holstein-Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; (K.L.); (D.B.); (J.H.); (U.F.W.); (T.K.)
| | - Jens Hoeppner
- Department of Surgery, University Medical Center of Schleswig-Holstein-Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; (K.L.); (D.B.); (J.H.); (U.F.W.); (T.K.)
| | - Ulrich F. Wellner
- Department of Surgery, University Medical Center of Schleswig-Holstein-Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; (K.L.); (D.B.); (J.H.); (U.F.W.); (T.K.)
| | - Dominik M. Schulte
- Division of Endocrinology, Diabetology and Clinical Nutrition, Department of Internal Medicine I, University Medical Center Schleswig-Holstein-Campus Kiel, 23538 Lübeck, Germany;
| | - Sebastian M. Schmid
- Institute for Endocrinology and Diabetes, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; (S.M.S.); (J.G.)
| | - Kim Luley
- Clinic for Hematology and Oncology, University Hospital Schleswig-Holstein-Campus Lübeck, 23538 Lübeck, Germany;
| | - Inga Buchmann
- Department of Radiology and Nuclear Medicine, University of Lübeck, Ratzeburger Alle 160, 23538 Lübeck, Germany;
| | - Lars Tharun
- Institute of Pathology, University Medical Center of Schleswig-Holstein-Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany;
| | - Tobias Keck
- Department of Surgery, University Medical Center of Schleswig-Holstein-Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; (K.L.); (D.B.); (J.H.); (U.F.W.); (T.K.)
| | - Judith Gebauer
- Institute for Endocrinology and Diabetes, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; (S.M.S.); (J.G.)
| | - Birte Kulemann
- Department of Surgery, University Medical Center of Schleswig-Holstein-Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; (K.L.); (D.B.); (J.H.); (U.F.W.); (T.K.)
- Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
- Correspondence:
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Fusai GK, Tamburrino D, Partelli S, Lykoudis P, Pipan P, Di Salvo F, Beghdadi N, Dokmak S, Wiese D, Landoni L, Nessi C, Busch ORC, Napoli N, Jang JY, Kwon W, Del Chiaro M, Scandavini C, Abu-Awwad M, Armstrong T, Hilal MA, Allen PJ, Javed A, Kjellman M, Sauvanet A, Bartsch DK, Bassi C, van Dijkum EJMN, Besselink MG, Boggi U, Kim SW, He J, Wolfgang CL, Falconi M. Portal vein resection during pancreaticoduodenectomy for pancreatic neuroendocrine tumors. An international multicenter comparative study. Surgery 2021; 169:1093-1101. [PMID: 33357999 DOI: 10.1016/j.surg.2020.11.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/18/2020] [Accepted: 11/02/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The role of portal vein resection for pancreatic cancer is well established but not for pancreatic neuroendocrine neoplasms. Evidence from studies providing information on long-term outcome after venous resection in pancreatic neuroendocrine neoplasms patients is lacking. METHODS This is a multicenter retrospective cohort study comparing pancreaticoduodenectomy with vein resection with standard pancreaticoduodenectomy in patients with pancreatic neuroendocrine neoplasms. The primary endpoint was to evaluate the long-term survival in both groups. Progression-free survival and overall survival were calculated using the method of Kaplan and Meier, but a propensity score-matched cohort analysis was subsequently performed to remove selection bias and improve homogeneity. The secondary outcome was Clavien-Dindo ≥3. RESULTS Sixty-one (11%) patients underwent pancreaticoduodenectomy with vein resection and 480 patients pancreaticoduodenectomy. Five (1%) perioperative deaths were recorded in the pancreaticoduodenectomy group, and postoperative clinically relevant morbidity rates were similar in the 2 groups (pancreaticoduodenectomy with vein resection 48% vs pancreaticoduodenectomy 33%). In the initial survival analysis, pancreaticoduodenectomy with vein resection was associated with worse 3-year progression-free survival (48% pancreaticoduodenectomy with vein resection vs 83% pancreaticoduodenectomy; P < .01) and 5-year overall survival (67% pancreaticoduodenectomy with vein resection vs 91% pancreaticoduodenectomy). After propensity score matching, no significant difference was found in both 3-year progression-free survival (49% pancreaticoduodenectomy with vein resection vs 59% pancreaticoduodenectomy; P = .14) and 5-year overall survival (71% pancreaticoduodenectomy with vein resection vs 69% pancreaticoduodenectomy; P = .98). CONCLUSION This study demonstrates no significant difference in perioperative risk with a similar overall survival between pancreaticoduodenectomy and pancreaticoduodenectomy with vein resection. Tumor involvement of the superior mesenteric/portal vein axis should not preclude surgical resection in patients with locally advanced pancreatic neuroendocrine neoplasms.
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Affiliation(s)
- Giuseppe K Fusai
- Department of HPB and Liver Transplant Surgery, Royal Free Hospital, London, United Kingdom
| | - Domenico Tamburrino
- Pancreatic Surgery Unit, Vita-Salute University, San Raffaele Hospital, Milan, Italy.
| | - Stefano Partelli
- Pancreatic Surgery Unit, Vita-Salute University, San Raffaele Hospital, Milan, Italy
| | - Panagis Lykoudis
- Department of HPB and Liver Transplant Surgery, Royal Free Hospital, London, United Kingdom
| | - Peter Pipan
- Department of HPB and Liver Transplant Surgery, Royal Free Hospital, London, United Kingdom
| | - Francesca Di Salvo
- Pancreatic Surgery Unit, Vita-Salute University, San Raffaele Hospital, Milan, Italy
| | - Nassiba Beghdadi
- Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif, Université de Paris-Paris Diderot, Beaujon Hospital, Clichy, France
| | - Safi Dokmak
- Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif, Université de Paris-Paris Diderot, Beaujon Hospital, Clichy, France
| | - Dominik Wiese
- Department of Visceral, Thoracic, and Vascular Surgery, Philipps University, Marburg, Germany
| | - Luca Landoni
- Unit of General and Pancreatic Surgery, University and Hospital Trust of Verona, Italy
| | - Chiara Nessi
- Unit of General and Pancreatic Surgery, University and Hospital Trust of Verona, Italy
| | - O R C Busch
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Netherlands
| | - Niccolò Napoli
- Division of General and Transplant Surgery, University of Pisa, Italy
| | - Jin-Young Jang
- Department of Surgery, Seoul National University College of Medicine, South Korea
| | - Wooil Kwon
- Department of Surgery, Seoul National University College of Medicine, South Korea
| | - Marco Del Chiaro
- Division of Surgical Oncology, Department of Surgery, University of Colorado Anschutz Medical Campus, Denver, CO
| | - Chiara Scandavini
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute, Department of Upper Gastrointestinal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Mahmoud Abu-Awwad
- Department of Surgery, University Hospital Southampton, United Kingdom
| | - Thomas Armstrong
- Department of Surgery, University Hospital Southampton, United Kingdom
| | - Mohamed Abu Hilal
- Department of Surgery, University Hospital Southampton, United Kingdom; Department of Surgery, Istituto Fondazione Poliambulanza, Brescia, Italy
| | - Peter J Allen
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Surgical Oncology, Duke University, Durham, NC
| | - Ammar Javed
- Division of Surgical Oncology, Surgical Oncology, Pathology and Oncology, Johns Hopkins Medical Institution, Baltimore, MD
| | - Magnus Kjellman
- Department of Molecular Medicine and Surgery, Division of Endocrine Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Alain Sauvanet
- Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif, Université de Paris-Paris Diderot, Beaujon Hospital, Clichy, France
| | - Detlef K Bartsch
- Department of Visceral, Thoracic, and Vascular Surgery, Philipps University, Marburg, Germany
| | - Claudio Bassi
- Unit of General and Pancreatic Surgery, University and Hospital Trust of Verona, Italy
| | - E J M Nieveen van Dijkum
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Netherlands
| | - M G Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Netherlands
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Italy
| | - Sun-Whe Kim
- Department of Surgery, Seoul National University College of Medicine, South Korea
| | - Jin He
- Division of Surgical Oncology, Surgical Oncology, Pathology and Oncology, Johns Hopkins Medical Institution, Baltimore, MD
| | - Christofer L Wolfgang
- Division of Surgical Oncology, Surgical Oncology, Pathology and Oncology, Johns Hopkins Medical Institution, Baltimore, MD
| | - Massimo Falconi
- Pancreatic Surgery Unit, Vita-Salute University, San Raffaele Hospital, Milan, Italy
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11
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Muniraj T, Aslanian HR. Pancreatic Neuroendocrine Tumors. GERIATRIC GASTROENTEROLOGY 2021:1933-1951. [DOI: 10.1007/978-3-030-30192-7_81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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12
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Worth PJ, Leal J, Ding Q, Trickey A, Dua MM, Chatzizacharias N, Soonawalla Z, Athanasopoulos P, Toumpanakis C, Hansen P, Parks RW, Connor S, Parker K, Koea J, Srinavasa S, Ielpo B, Vicente Lopez E, Lawrence B, Visser BC. Pancreatic grade 3 neuroendocrine tumors behave similarly to neuroendocrine carcinomas following resection: a multi-center, international appraisal of the WHO 2010 and WHO 2017 staging schema for pancreatic neuroendocrine lesions. HPB (Oxford) 2020; 22:1359-1367. [PMID: 32081540 DOI: 10.1016/j.hpb.2019.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 12/28/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND In 2017, the WHO updated their 2010 classification of pancreatic neuroendocrine tumors, introducing a well-differentiated, highly proliferative grade 3 tumor, distinct from neuroendocrine carcinomas. The aim of this study was to investigate the clinical significance of this update in a large cohort of resected tumors. METHODS Using a multicenter, international dataset of patients with pancreatic neuroendocrine lesions, patients were classified both according to the WHO 2010 and 2017 schema. Multivariable survival analyses were performed, and the models were evaluated for discrimination ability and goodness of fit. RESULTS Excluding patients with a known germline MEN1 mutation and incomplete data, 544 patients were analyzed. The performance of the WHO 2010 and 2017 models was similar, however surgically resected grade 3 tumors behaved very similarly to neuroendocrine carcinomas. CONCLUSION The addition of a grade 3 NET classification may be of limited utility in surgically resected patients, as these lesions have similar postoperative survival compared to carcinomas. While the addition may allow for a more granular evaluation of novel treatment strategies, surgical intervention for high grade tumors should be considered judiciously.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Paul Hansen
- Providence Portland Cancer Center, United States
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13
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Yu YJ, Li YW, Shi Y, Zhang Z, Zheng MY, Zhang SW. Clinical and pathological characteristics and prognosis of 132 cases of rectal neuroendocrine tumors. World J Gastrointest Oncol 2020; 12:893-902. [PMID: 32879666 PMCID: PMC7443838 DOI: 10.4251/wjgo.v12.i8.893] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/26/2020] [Accepted: 07/19/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Neuroendocrine tumors (NETs) frequently occur in the gastrointestinal tract, lung, and pancreas, and the rectum and appendix are the sites with the highest incidence. Epidemiology statistics show that an estimated 8000 people every year in the United States are diagnosed with NETs occurring in the gastrointestinal tract, including the stomach, intestine, appendix, colon, and rectum. The pathological changes and clinical symptoms of NETs are not specific, and therefore they are frequently misdiagnosed. AIM To investigate the clinical symptoms, pathological characteristics, treatment, and prognosis of rectal neuroendocrine tumors (RNETs) by analyzing the clinical and pathological data of 132 RNET cases at our hospital. METHODS All RNETs were graded according to Ki-67 positivity and mitotic events. The tumors were staged as clinical stages I, II, III, and IV according to infiltrative depth and tumor size. COX proportional hazard model was used to assess the main risk factors for survival. RESULTS These 132 RNETs included 83 cases of G1, 21 cases of G2, and 28 cases of G3 (neuroendocrine carcinoma) disease. Immunohistochemical staining showed that 89.4% of RNETs were positive for synaptophysin and 39.4% positive for chromogranin A. There were 19, 85, 23, and 5 cases of clinical stages I, II, III, and IV, respectively. The median patient age was 52.96 years. The diameter of tumor, depth of invasion, and pathological grade were the main reference factors for the treatment of RNETs. The survival rates at 6, 12, 36, and 60 mo after operation were 98.5%, 94.6%, 90.2%, and 85.6%, respectively. Gender, tumor size, tumor grade, lymph node or distant organ metastasis, and radical resection were the main factors associated with prognosis of RNETs. Multivariate analysis showed that tumor size and grade were independent prognostic factors. CONCLUSION The clinical symptoms of RNETs are not specific, and they are easy to misdiagnose. Surgery is the main treatment method. The grade and stage of RNETs are the main indices to evaluate prognosis.
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Affiliation(s)
- Yong-Jun Yu
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin 300121, China
| | - Yu-Wei Li
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin 300121, China
| | - Yang Shi
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin 300121, China
| | - Zhao Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin 300121, China
| | - Min-Ying Zheng
- Department of Pathology, Tianjin Union Medical Center, Tianjin 300121, China
| | - Shi-Wu Zhang
- Department of Pathology, Tianjin Union Medical Center, Tianjin 300121, China
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14
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Liver metastases in gastroenteropancreatic neuroendocrine tumours - treatment methods. GASTROENTEROLOGY REVIEW 2020; 15:207-214. [PMID: 33005265 PMCID: PMC7509904 DOI: 10.5114/pg.2020.91501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/30/2019] [Indexed: 12/13/2022]
Abstract
Surgical approaches that allow the safe treatment of multiple, bilateral, large tumours, and that combine extirpative, ablative and interventional therapies, have expanded the population of patients with neuroendocrine tumors (NET) liver metastases (LMs) who can benefit from aggressive treatment of their liver disease. Pre-treatment staging often includes the biochemical assessment of serologic markers such as serotonin, insulin, vasoactive intestinal peptide, and chromogranin, even in patients without clinically apparent hormonal excess. Radiofrequency ablation (RFA) is a technique that involves the use of thermal energy to induce coagulation necrosis, thereby destroying tumour cells. Resection plus RFA is increasingly used in patients with bilateral NET LMs. Resection is performed for large or dominant lesions, while ablation is used to treat small lesions. Hepatic arterial embolization, typically termed transarterial embolization, and transarterial chemoembolization have been shown to induce a reduction in tumour size and to ameliorate symptoms of excess hormonal secretion.
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15
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Darbà J, Marsà A. Exploring the current status of neuroendocrine tumours: a population-based analysis of epidemiology, management and use of resources. BMC Cancer 2019; 19:1226. [PMID: 31842791 PMCID: PMC6915958 DOI: 10.1186/s12885-019-6412-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 11/29/2019] [Indexed: 12/17/2022] Open
Abstract
Background Neuroendocrine tumours (NETs) are rare malignancies characterised by its capacity to synthesise and secrete monoamines, due to its neuroendocrine origin. Its varied locations and symptoms have traditionally been responsible for extended delays in their diagnosis. The interest of this study was to characterise the patient population diagnosed with NETs in Spain and to revise how the disease is managed, together with the hospitalisation costs of these patients. Methods The database included records of all patients diagnosed with a NET between 2010 and 2015. Admission records were used to evaluate hospitalisation, disease management data and costs, and single-patient files were used to characterise the population. Results Nine Thousand One Hundred Twenty patients were diagnosed with a neuroendocrine tumour between 2010 and 2015, with a 2 fold increase in the diagnosis rate over the study period. 42.25% of the patients were females, while 57.75% were males, and mean diagnosis age was 62.58 years (SD = 14.65). Considering all the registered neuroendocrine neoplasms, 46.86% of the patients had malignant well-differentiated NETs, 32.02% had a malignant poorly differentiated neuroendocrine carcinoma and 42.93% of patients developed metastatic NETs. In addition, 18.59% of patients were diagnosed with benign well-differentiated NETs. The most common tumour sites were the bronchus, lung and other sites, including pancreatic tumours; metastasis was found in the liver and distant lymph nodes. Pancreatic resection was the most common surgical procedure utilised in these patients, summing 19% of total expenses, the injection of an unspecified therapeutic substance (including targeted therapies) was registered in 11.40% of admissions, while chemotherapy was registered in only 6.85% of admissions. The annual healthcare cost of NETs was €15,373,961, corresponding to €9092 per patient. Conclusions The implementation of standard diagnosis procedures should be prioritised, with a focus on the pancreas and lung, and taking into account that 42.93% of the patients develop a metastatic tumour. The presence of comorbidities and multimorbidities should be considered in order to develop more efficient disease management protocols.
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Affiliation(s)
- Josep Darbà
- Universitat de Barcelona, Department of Economics, Diagonal 696, 08034, Barcelona, Spain.
| | - Alicia Marsà
- BCN Health Economics & Outcomes Research S.L., Travessera de Gràcia, 62, 08006, Barcelona, Spain
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16
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Coco D, Leanza S, Guerra F. Total Pancreatectomy: Indications, Advantages and Disadvantages - A Review. MAEDICA 2019; 14:391-396. [PMID: 32153671 PMCID: PMC7035443 DOI: 10.26574/maedica.2019.14.4.391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Total pancreatectomy is an obligatory surgical procedure in locally advanced or centrally located pancreatic neoplasms to achieve complete tumour clearance. Owing to sound understanding of tumour biology and evolution in intervention technique and improved postoperative care, nowadays the indications of total pancreatectomy have taken a significant change. Aim: To review the indications of total pancreatectomy and its advantages and disadvantages under current perspectives. Method: Major databases, including PubMed, EMBASE, Science Citation Index Expanded, Scopus and the Cochrane Library, were searched for studies of total pancreatectomy and the results reported by various authors were summarized. Results: The indications of total pancreatectomy in subjects diagnosed with chronic pancreatitis were classified into four subgroups, including "Tumour", "Trouble", "Technical difficulties" and "Therapy-refractory pain". Today, total pancreatectomy has more specific and different indications than before. Currently, IPMN (intraductal papillary mucinous neoplasm) seems to have the most essential indication quantitatively. Morbidity and mortality related to total pancreatectomy are more profoundly decreased than before due to improvements in the operative techniques and post-operative managements. Some of the metabolic disorders are reported as major disadvantages of total pancreatectomy. Conclusion: Despite the disadvantages of total pancreatectomy, it remains an inevitable procedure for subjects with chronic pancreatitis, improvements in operative techniques and postoperative management ensuring long-term survival, a better quality of life, and diminished mortality and morbidity rates.
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Affiliation(s)
- Danilo Coco
- Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Silvana Leanza
- Department of General Surgery Carlo Urbani Hospital, Jesi, Italy
| | - Francesco Guerra
- Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
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17
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Abdullayeva L. VIPoma: Mechanisms, clinical presentation, diagnosis and treatment (Review). WORLD ACADEMY OF SCIENCES JOURNAL 2019. [DOI: 10.3892/wasj.2019.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
Affiliation(s)
- Leila Abdullayeva
- Department of Clinical Anatomy and Operative Surgery, Joint Stock Company ‘National Medical University’, A05H2A0 Almaty, Kazakhstan
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18
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Abstract
OBJECTIVE To determine the role of reoperation in patients with persistent or recurrent Zollinger-Ellison Syndrome (ZES). BACKGROUND Approximately, 0% to 60% of ZES patients are disease-free (DF) after an initial operation, but the tumor may recur. METHODS A prospective database was queried. RESULTS A total of 223 patients had an initial operation for possible cure of ZES and then were subsequently evaluated serially with cross sectional imaging-computed tomography, magnetic resonance imaging, ultrasound, more recently octreoscan-and functional studies for ZES activity. The mean age at first surgery was 49 years and with an 11-year mean follow-up 52 patients (23%) underwent reoperation when ZES recurred with imageable disease. Results in this group are analyzed in the current report. Reoperation occurred on a mean of 6 years after the initial surgery with a mean number of reoperations of 1 (range 1-5). After reoperation 18/52 patients were initially DF (35%); and after a mean follow-up of 8 years, 13/52 remained DF (25%). During follow-up, 9/52 reoperated patients (17%) died, of whom 7 patients died a disease-related death (13%). The overall survival from first surgery was 84% at 20 years and 68% at 30 years. Multiple endocrine neoplasia type 1 status did not affect survival, but DF interval and liver metastases did. CONCLUSIONS These results demonstrate that a significant proportion of patients with ZES will develop resectable persistent or recurrent disease after an initial operation. These patients generally have prolonged survival after reoperation and 25% can be cured with repeat surgery, suggesting all ZES patients postresection should have systematic imaging, and if tumor recurs, advise repeat operation.
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19
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Barry L, McFadden DW. Gastrointestinal Carcinoid Tumors. SHACKELFORD'S SURGERY OF THE ALIMENTARY TRACT, 2 VOLUME SET 2019:939-950. [DOI: 10.1016/b978-0-323-40232-3.00080-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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20
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Takase Y, Naito Y, Okabe Y, Ishida Y, Yamaguchi T, Abe H, Murata K, Ito T, Tanigawa M, Kawahara A, Yano H, Akiba J. Insulinoma-associated protein 1 expression in pancreatic neuroendocrine tumours in endoscopic ultrasound-guided fine-needle aspiration cytology: An analysis of 14 patients. Cytopathology 2018; 30:194-200. [PMID: 30290028 DOI: 10.1111/cyt.12640] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/23/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Insulinoma-associated protein 1 (INSM1) has been reported to be a useful marker for diagnosing pancreatic neuroendocrine tumours (PNETs). However, INSM1 expression in endoscopic ultrasound-guided fine needle aspiration cytology has not been examined. We evaluated INSM1 expression in the cytology of cases diagnosed with PNETs. METHODS We immunocytochemically stained INSM1 and Ki-67 in 14 PNET cases, and according to the 2017 World Health Organisation criteria, seven PNET Grade 1 cases, four Grade 2 cases and three Grade 3/neuroendocrine carcinoma cases were identified. As a control for INSM1 and Ki-67 expression, we used cytological specimens from 15 cases of pancreatic ductal adenocarcinoma. RESULTS In PNET cases, INSM1-expressing tumour cells were identified in all cytological specimens of PNET. The median INSM1 expression rate in Grade 1 cases was 49.8% (mean ± standard deviation: 55.1 ± 12.5%, min: 39.3%, max: 74.1%), and in Grade 2 and Grade 3/neuroendocrine carcinoma cases was 81.1% (mean ± standard deviation: 77.6 ± 18.6%, min: 50.3%, max: 100%). However, there was no correlation between INSM1 and Ki-67 expression (r = -0.15). The median expression rate in PNET cases was 64.3%, which was significantly higher than that in pancreatic ductal adenocarcinoma cases (P < 0.0001). CONCLUSION INSM1 immunocytochemistry of cytological specimens obtained from endoscopic ultrasound-guided fine needle aspiration cytology can accurately diagnose PNETs; therefore, INSM1 could be an important diagnostic tool in assessing therapeutic strategies, including molecular-targeted therapy.
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Affiliation(s)
- Yorihiko Takase
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
| | - Yoshiki Naito
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan.,Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Yoshinobu Okabe
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Yusuke Ishida
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Tomohiko Yamaguchi
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
| | - Hideyuki Abe
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
| | - Kazuya Murata
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
| | - Takaaki Ito
- Department of Pathology and Experimental Medicine, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Masahiko Tanigawa
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Akihiko Kawahara
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
| | - Hirohisa Yano
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Jun Akiba
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
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21
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Chouliaras K, Newman NA, Shukla M, Swett KR, Levine EA, Sham J, Mann GN, Shen P. Analysis of recurrence after the resection of pancreatic neuroendocrine tumors. J Surg Oncol 2018; 118:416-421. [PMID: 30259518 DOI: 10.1002/jso.25146] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/30/2018] [Accepted: 06/04/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES Outcomes after recurrence of resected pancreatic neuroendocrine tumors (PNETs) are not well described. We aim to assess the rate and sites of recurrence, and its effect on clinical outcomes. METHODS Retrospective chart review of patients (n = 83) who underwent surgical resection of PNETs at 2 institutions. Patients were treated from September 2002 to July 2010. RESULTS There were 13 (16%) recurrences. The most common site of recurrence was the liver (9 patients, 9.6%). The most common treatment of recurrences was chemotherapy (5 patients, 36%). The 1-, 3-, and 5-year disease-free survival was 90.9%, 82.7%, and 72.5%, respectively. Median recurrence-free survival was 127 months. The median follow-up for all PNET patients was 25.8 months (range, 1-140 months). The 3-year survival was 97%. The median follow-up of patients after the diagnosis of a recurrence was 13.8 months. The overall survival for those with and without recurrence was 96.3% and 100%, respectively (P = .36). The age ( P = .002) and lymph node ratio ( P < .001) were predictors of recurrence on multivariate analysis. CONCLUSIONS Age and lymph node ratio are significant predictors of recurrence after the resection of PNETs with hepatic metastases being the most common. Survival of patients with recurrence is not significantly different from patients without recurrence.
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Affiliation(s)
- Konstantinos Chouliaras
- Department of General Surgery, Surgical Oncology Section, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Naeem A Newman
- Department of General Surgery, Surgical Oncology Section, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Mrinal Shukla
- Department of General Surgery, Surgical Oncology Section, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Katrina R Swett
- Department of General Surgery, Surgical Oncology Section, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Edward A Levine
- Department of General Surgery, Surgical Oncology Section, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Jonathan Sham
- Department of Surgery, Section of Surgical Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Gary N Mann
- Department of Surgery, Section of Surgical Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Perry Shen
- Department of General Surgery, Surgical Oncology Section, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, North Carolina
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Watson GA, Ahmed Y, Picardo S, Chew S, Cobbe S, Mahony C, Crotty J, Wallis F, Shelly MJ, Kiely P, Ipadeola OB, Healy V, Osman N, Gupta RK. Unusual Sites of High-Grade Neuroendocrine Carcinomas: A Case Series and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:710-723. [PMID: 29915166 PMCID: PMC6044230 DOI: 10.12659/ajcr.908953] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Case series Patient: Female, 29 • Female, 69 • Female, 52 • Female, 71 • Male, 62 • Female, 67 Final Diagnosis: Neuroendocrine carcinoma Symptoms: Abdominal pain Medication: — Clinical Procedure: — Specialty: Oncology
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Affiliation(s)
- Geoffrey A Watson
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
| | - Yasar Ahmed
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
| | - Sarah Picardo
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
| | - Sonya Chew
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
| | - Shona Cobbe
- Graduate Entry Medical School, University Hospital Limerick, Limerick, Ireland
| | - Cillian Mahony
- Graduate Entry Medical School, University Hospital Limerick, Limerick, Ireland
| | - James Crotty
- Department of Radiology, University Hospital Limerick, Limerick, Ireland
| | - Fintan Wallis
- Department of Radiology, University Hospital Limerick, Limerick, Ireland
| | - Martin J Shelly
- Department of Radiology, University Hospital Limerick, Limerick, Ireland
| | - Patrick Kiely
- Department of Radiology, University Hospital Limerick, Limerick, Ireland
| | - Olu Bunmi Ipadeola
- Department of Histopathology, University Hospital Limerick, Limerick, Ireland
| | - Vourneen Healy
- Department of Histopathology, University Hospital Limerick, Limerick, Ireland
| | - Nemer Osman
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
| | - Rajnish K Gupta
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School, University Hospital Limerick, Limerick, Ireland
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Surgical treatment of pNET - Experience of a "high-volume" center. Surg Oncol 2018; 27:409-414. [PMID: 30217295 DOI: 10.1016/j.suronc.2018.05.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 05/18/2018] [Accepted: 05/28/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Neuroendocrine tumors of the pancreas (pNETs) are a rare disease. Grading according to the Ki67-index is the most validated risk factor. Nevertheless, controversies exist concerning other prognostic factors. The aim of this study was to evaluate published risk factors. METHODS Patients with pancreatic NETs who underwent surgery at our department from 2000 to 2014 were analyzed. The patient and tumor characteristics were evaluated. Kaplan-Meier analyses, univariate calculations as well as multivariate analyses were performed. RESULTS In total, 98 patients underwent surgery due to a pNET. The final study population consisted of 88 patients. Univariate analysis demonstrated that overall survival is influenced by tumor grading, local resection margin and presence of distant metastases. However, in the multivariate analysis, only grading and the resection margin had prognostic significance. The size of the primary tumor directly correlated with the probability of metastases. Multivisceral operations had no influence on morbidity or mortality. CONCLUSIONS Resection of pNETs is the only curative treatment and is safe. Since the incidence of pNETs is low, treatment should be performed at a high-volume center.
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24
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Tanno L, Mayo D, Mills S, Takhar A, Cave J, Nolan L, Stedman B, Sundram FX, Abu Hilal M, Connor H, Pearce N, Armstrong T. Proactive multi-modality treatment of Pancreatic Neuroendocrine Tumours (PNETs): Potential survival benefits. Pancreatology 2018; 18:304-312. [PMID: 29433805 DOI: 10.1016/j.pan.2017.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/15/2017] [Accepted: 12/11/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Primary and metastatic pancreatic neuroendocrine tumours (PNET) can be treated with combination of surgery, locoregional and systemic therapy. Survival benefits from individual treatments have been well reported, however, the combined outcome from multimodal treatments are not well described in the literature. We report outcomes in a cohort of PNET patients treated with proactive, multimodality therapy. METHODS 106 patients were identified from a single tertiary referral centre prospective database. Outcomes of treatment were studied, with the primary end point being death from any cause. RESULTS Median follow-up was 71 months and overall 5-year survival of 62%. In patients with stage I-III disease (51 patients) estimated 5-year survival was 90%. Median survival in patients with stage IV disease was 51 months with an estimated 5-year survival of 40% in this group. A total of 80 patients (75%) had surgery of which 16% suffered complications requiring intervention. There was no perioperative mortality. CONCLUSIONS This study demonstrates that proactive multimodal treatment is safe and may confer a survival benefit to patients in this cohort compared to historical data.
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Affiliation(s)
- L Tanno
- Department of Hepatobiliary Surgery, Wessex NET Group ENETS Centre of Excellence, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, United Kingdom.
| | - D Mayo
- Department of Hepatobiliary Surgery, Wessex NET Group ENETS Centre of Excellence, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, United Kingdom
| | - S Mills
- Department of Hepatobiliary Surgery, Wessex NET Group ENETS Centre of Excellence, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, United Kingdom
| | - A Takhar
- Department of Hepatobiliary Surgery, Wessex NET Group ENETS Centre of Excellence, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, United Kingdom
| | - J Cave
- Department of Oncology, Wessex NET Group ENETS Centre of Excellence, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, United Kingdom
| | - L Nolan
- Department of Oncology, Wessex NET Group ENETS Centre of Excellence, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, United Kingdom
| | - B Stedman
- Department of Interventional Radiology, Wessex NET Group ENETS Centre of Excellence, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, United Kingdom
| | - F X Sundram
- Department of Nuclear Medicine, Wessex NET Group ENETS Centre of Excellence, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, United Kingdom
| | - M Abu Hilal
- Department of Hepatobiliary Surgery, Wessex NET Group ENETS Centre of Excellence, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, United Kingdom
| | - H Connor
- Department of Hepatobiliary Surgery, Wessex NET Group ENETS Centre of Excellence, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, United Kingdom
| | - N Pearce
- Department of Hepatobiliary Surgery, Wessex NET Group ENETS Centre of Excellence, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, United Kingdom
| | - T Armstrong
- Department of Hepatobiliary Surgery, Wessex NET Group ENETS Centre of Excellence, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, United Kingdom
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25
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Sadowski SM, Cadiot G, Dansin E, Goudet P, Triponez F. The future: surgical advances in MEN1 therapeutic approaches and management strategies. Endocr Relat Cancer 2017; 24:T243-T260. [PMID: 28811298 DOI: 10.1530/erc-17-0285] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 08/15/2017] [Indexed: 12/16/2022]
Abstract
Multiple endocrine neoplasia type 1 (MEN1) is a hereditary autosomal dominant disorder associated with numerous neuroendocrine tumors (NETs). Recent advances in the management of MEN1 have led to a decrease in mortality due to excess hormones; however, they have also led to an increase in mortality from malignancy, particularly NETs. The main challenges are to localize these tumors, to select those that need therapy because of the risk of aggressive behavior and to select the appropriate therapy associated with minimal morbidity. This must be applied to a hereditary disease with a high risk of recurrence. The overall aim of management in MEN1 is to ensure that the patient remains disease- and symptom-free for as long as possible and maintains a good quality of life. Herein, we review the changes that occurred in the last 20 years in the surgical management of MEN1-associated functional and non-functional pancreatico-duodenal NETs and thymic and bronchial NETs.
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Affiliation(s)
- S M Sadowski
- Thoracic and Endocrine Surgery and Faculty of MedicineUniversity Hospitals of Geneva, Geneva, Switzerland
| | - G Cadiot
- Gastroenterology and HepatologyUniversity Hospital of Reims, Reims, France
| | - E Dansin
- OncologyOscar Lambret Cancer Center, University of Lille, Lille, France
| | - P Goudet
- Endocrine SurgeryUniversity Hospital of Dijon, and INSERM, U866, Epidemiology and Clinical Research in Digestive Oncology Team, and INSERM, CIC1432, Clinical Epidemiology Unit, University Hospital of Dijon, Clinical Investigation Centre, Clinical Epidemiology/Clinical Trials Unit, Dijon, France
| | - F Triponez
- Thoracic and Endocrine Surgery and Faculty of MedicineUniversity Hospitals of Geneva, Geneva, Switzerland
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26
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Abstract
We present a rare case in an elderly Caucasian lady of primary ovarian carcinoid tumor, causing symptoms of the carcinoid syndrome and severe carcinoid heart disease. Carcinoid tumors are the commonest neuroendocrine tumors, the majority of which are found in the gastrointestinal tract and lungs. Ovarian carcinoids represent only 0.1% of all ovarian neoplasms and 1% of all carcinoid tumors. Carcinoid syndrome can present with flushing, diffuse watery diarrhea, wheezing and breathlessness and in advanced cases lead to carcinoid heart disease. This involves damage to the right heart structures and pulmonary hypertension, which can cause significant breathlessness and peripheral edema, and is associated with a worse prognosis. Diagnosis involves multi-modality radiological imaging and biochemical analysis of neuroendocrine tumor markers, and the first line treatment should always be resection of the tumor where possible. Prognosis is generally favorable, except in some cases with metastasis.
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Affiliation(s)
- Karan Saraf
- a Royal Lancaster Infirmary , Lancaster , UK
| | | | | | - Sanjay Sinha
- b Furness General Hospital , Barrow-in-Furness , UK
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27
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Ware MJ, Nguyen LP, Law JJ, Krzykawska-Serda M, Taylor KM, Cao HST, Anderson AO, Pulikkathara M, Newton JM, Ho JC, Hwang R, Rajapakshe K, Coarfa C, Huang S, Edwards D, Curley SA, Corr SJ. A new mild hyperthermia device to treat vascular involvement in cancer surgery. Sci Rep 2017; 7:11299. [PMID: 28900126 PMCID: PMC5595878 DOI: 10.1038/s41598-017-10508-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 08/09/2017] [Indexed: 01/04/2023] Open
Abstract
Surgical margin status in cancer surgery represents an important oncologic parameter affecting overall prognosis. The risk of disease recurrence is minimized and survival often prolonged if margin-negative resection can be accomplished during cancer surgery. Unfortunately, negative margins are not always surgically achievable due to tumor invasion into adjacent tissues or involvement of critical vasculature. Herein, we present a novel intra-operative device created to facilitate a uniform and mild heating profile to cause hyperthermic destruction of vessel-encasing tumors while safeguarding the encased vessel. We use pancreatic ductal adenocarcinoma as an in vitro and an in vivo cancer model for these studies as it is a representative model of a tumor that commonly involves major mesenteric vessels. In vitro data suggests that mild hyperthermia (41-46 °C for ten minutes) is an optimal thermal dose to induce high levels of cancer cell death, alter cancer cell's proteomic profiles and eliminate cancer stem cells while preserving non-malignant cells. In vivo and in silico data supports the well-known phenomena of a vascular heat sink effect that causes high temperature differentials through tissues undergoing hyperthermia, however temperatures can be predicted and used as a tool for the surgeon to adjust thermal doses delivered for various tumor margins.
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Affiliation(s)
- Matthew J Ware
- Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Lam P Nguyen
- Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Justin J Law
- Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Martyna Krzykawska-Serda
- Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
- Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Gronostajowa 7 St., Kraków, 30-387, Poland
| | - Kimberly M Taylor
- Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Hop S Tran Cao
- Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Andrew O Anderson
- Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | | | - Jared M Newton
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
- Interdepartmental program in Translational Biology and Molecular Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Jason C Ho
- Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Rosa Hwang
- Department of Surgical oncology, MD Anderson, Houston, Texas, 77030, USA
| | - Kimal Rajapakshe
- Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, Texas, 77030, USA
| | - Cristian Coarfa
- Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, Texas, 77030, USA
| | - Shixia Huang
- Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, Texas, 77030, USA
| | - Dean Edwards
- Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, Texas, 77030, USA
| | - Steven A Curley
- Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA.
- Department of Mechanical Engineering and Materials Science, Rice University, Houston, TX, 77005, USA.
| | - Stuart J Corr
- Department of Surgery, Baylor College of Medicine, Houston, TX, 77030, USA.
- Department of Chemistry, Rice University, Houston, TX, 77030, USA.
- Department of Biomedical Engineering, University of Houston, Houston, 77204, TX, USA.
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28
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Maker AV, Sheikh R, Bhagia V. Perioperative management of endocrine insufficiency after total pancreatectomy for neoplasia. Langenbecks Arch Surg 2017; 402:873-883. [PMID: 28733926 DOI: 10.1007/s00423-017-1603-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 07/07/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE Indications for total pancreatectomy (TP) have increased, including for diffuse main duct intrapapillary mucinous neoplasms of the pancreas and malignancy; therefore, the need persists for surgeons to develop appropriate endocrine post-operative management strategies. The brittle diabetes after TP differs from type 1/2 diabetes in that patients have absolute deficiency of insulin and functional glucagon. This makes glucose management challenging, complicates recovery, and predisposes to hospital readmissions. This article aims to define the disease, describe the cause for its occurrence, review the anatomy of the endocrine pancreas, and explain how this condition differs from diabetes mellitus in the setting of post-operative management. The morbidity and mortality of post-TP endocrine insufficiency and practical treatment strategies are systematically reviewed from the literature. Finally, an evidence-based treatment algorithm is created for the practicing pancreatic surgeon and their care team of endocrinologists to aid in managing these complex patients. METHODS A PubMed, Science Citation Index/Social sciences Citation Index, and Cochrane Evidence-Based Medicine database search was undertaken along with extensive backward search of the references of published articles to identify studies evaluating endocrine morbidity and treatment after TP and to establish an evidence-based treatment strategy. RESULTS Indications for TP and the etiology of pancreatogenic diabetes are reviewed. After TP, ~80% patients develop hypoglycemic episodes and 40% experience severe hypoglycemia, resulting in 0-8% mortality and 25-45% morbidity. Referral to a nutritionist and endocrinologist for patient education before surgery followed by surgical reevaluation to determine if the patient has the appropriate understanding, support, and resources preoperatively has significantly reduced morbidity and mortality. The use of modern recombinant long-acting insulin analogues, continuous subcutaneous insulin infusion, and glucagon rescue therapy has greatly improved management in the modern era and constitute the current standard of care. A simple immediate post-operative algorithm was constructed. CONCLUSION Successful perioperative surgical management of total pancreatectomy and resulting pancreatogenic diabetes is critical to achieve acceptable post-operative outcomes, and we review the pertinent literature and provide a simple, evidence-based algorithm for immediate post-resection glycemic control.
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Affiliation(s)
- Ajay V Maker
- Department of Surgery, Division of Surgical Oncology, University of Illinois at Chicago, 835 S. Wolcott Ave. MC790, Chicago, IL, 60612, USA.
- Creticos Cancer Center, Advocate Illinois Masonic Medical Center, University of Illinois Metropolitan Group Hospitals Residency Program in General Surgery, Chicago, IL, USA.
| | - Raashid Sheikh
- Creticos Cancer Center, Advocate Illinois Masonic Medical Center, University of Illinois Metropolitan Group Hospitals Residency Program in General Surgery, Chicago, IL, USA
| | - Vinita Bhagia
- Department of Medicine, Division of Endocrinology, University of Illinois at Chicago and Creticos Cancer Center at Advocate Illinois Masonic Medical Center, Chicago, IL, USA
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29
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Gaikwad V, Patkar S, Barreto SG, Sirohi B, Goel M, Shrikhande SV. Outcomes of 101 Consecutive Surgical Resections of Gastroenteropancreatic Neuroendocrine Tumours (GEPNETs) at Tata Memorial Hospital: a Referral Bias for Nonfunctional Duodenopancreatic Tumours and the Need for Greater Awareness of GEPNETs as a Distinct Entity. Indian J Surg 2017; 79:226-233. [PMID: 28659676 PMCID: PMC5473788 DOI: 10.1007/s12262-016-1453-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 02/10/2016] [Indexed: 10/22/2022] Open
Abstract
Data from India regarding the disease spectrum and surgical results of neuroendocrine tumours (GEPNETs) are sparse. Tempered surgical radicality in a high-volume oncology centre, conforming to existing guidelines, may further our understanding of tumour characteristics and behavioural patterns of nonfunctional GEPNETs. Surgical outcomes of patients with histopathologically confirmed GEPNETs from January 2003 to December 2013 were analyzed from a prospectively maintained database. Tumour grade, organ of primary tumour, perioperative factors, quality/radicality of resection and presence of metastatic disease were correlated with perioperative outcomes, overall survival and disease-free survival. Ninety of the 101 operated patients had nonfunctional tumours. These comprised radical resections (n = 69), organ-preserving procedures (n = 16) and inoperable tumours (n = 5). The primary tumour sites were pancreatic in 48 patients and gastroenteric in 42 patients. The overall perioperative morbidity and mortality rates were 30 and 3 %, respectively. Fifteen patients harboured metastatic disease at presentation. At a median follow-up of 22 months, 18 patients had residual disease, 7 developed recurrences and 10 patients died. The estimated actuarial 5-year overall survival was 81.6 %, and disease-free survival was 67.2 %. Tumour grade and organ of origin (pancreatic vs. gastroenteric) did not influence long-term survival (p = 0.315 and p = 0.624, respectively), but presence of metastatic disease at presentation significantly affected long-term survival (p = 0.009). Nonfunctional pancreatic/duodenal neuroendocrine tumours (NETs) accounted for 76 % of surgical resections at our centre with the minority being other resections. In selected patients with nonfunctional NETs, organ-preserving surgery may provide equivalent long-term survival with decreased operative morbidity. Although tumour grade is considered to be an important prognostic factor, the presence of metastatic disease at presentation also determines long-term survival. The referral bias suggests the need for greater awareness given the favourable long-term outcomes of these tumours. There is a need to correct this referral bias by increasing the awareness of GEPNETs in India.
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Affiliation(s)
- Vinay Gaikwad
- Department of Surgical Oncology, Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai, 400 012 India
| | - Shraddha Patkar
- Department of Surgical Oncology, Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai, 400 012 India
| | - Savio George Barreto
- Department of Surgical Oncology, Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai, 400 012 India
| | - Bhawna Sirohi
- Department of Surgical Oncology, Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai, 400 012 India
- Department of Medical Oncology, Gastrointestinal Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Mahesh Goel
- Department of Surgical Oncology, Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai, 400 012 India
| | - Shailesh V. Shrikhande
- Department of Surgical Oncology, Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai, 400 012 India
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30
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Finkelstein P, Sharma R, Picado O, Gadde R, Stuart H, Ripat C, Livingstone AS, Sleeman D, Merchant N, Yakoub D. Pancreatic Neuroendocrine Tumors (panNETs): Analysis of Overall Survival of Nonsurgical Management Versus Surgical Resection. J Gastrointest Surg 2017; 21:855-866. [PMID: 28255853 DOI: 10.1007/s11605-017-3365-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 01/05/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Outcomes of patients with pancreatic neuroendocrine tumors (panNETs) undergoing surgical or nonsurgical management and outcomes of enucleation versus standard resection were compared. METHODS MEDLINE, EMBASE, PubMed, Scopus, and Cochrane were queried (2000 to present). All studies comparing patients undergoing surgical versus nonsurgical treatments, or enucleation versus standard resection, were included. Pooled risk ratios and 95% CI for survival were calculated. RESULTS Eleven studies met criteria with 1491 resected and 1607 nonsurgically managed patients. Meta-analysis showed improved overall survival with resection at 1 year (risk ratio (RR) = 1.281, CI 1.064-1.542, p = 0.009), 3 years (RR = 1.837, CI 1.594-2.117, p < 0.001), and 5 years (RR = 2.103, CI 1.50-2.945, p < 0.001). OS of patients with resected nonfunctioning panNETs was improved at 3 years (RR = 1.847, CI 1.477-2.309, p < 0.001) and 5 years (RR = 1.767, CI 1.068-2.924, p = 0.027). OS was improved when panNETs ≤2 cm were resected at 3 years (RR = 1.695, CI 1.269-2.264, p < 0.001) and 5 years (RR = 2.210, CI 1.749-2.791, p < 0.001). Fifteen articles met criteria for enucleation versus standard resection (n = 1035; 620 were nonfunctioning). Enucleation had shorter operative time (weighted mean difference (WMD) = -95.6 min, 95% CI -131.4 to -59.8, p < 0.01), less operative blood loss (WMD = -172.6 ml, 95% CI -340 to -5.1, p = 0.04), but increased postoperative pancreatic fistula (POPF) (RR = 2.08, 95% CI 1.39-3.12, p < 0.01). CONCLUSION Surgical resection of panNETs, including small and nonfunctioning, appears to be associated with improved OS. Enucleation is associated with shorter operative time, less blood loss, but greater incidence of POPF. Prospective, randomized clinical trials are needed to confirm these results.
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Affiliation(s)
- Paige Finkelstein
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Rishika Sharma
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Omar Picado
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Rahul Gadde
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Heather Stuart
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Caroline Ripat
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Alan S Livingstone
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Danny Sleeman
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Nipun Merchant
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Danny Yakoub
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA.
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ElGuindy YM, Javadi S, Menias CO, Jensen CT, Elsamaloty H, Elsayes KM. Imaging of secretory tumors of the gastrointestinal tract. Abdom Radiol (NY) 2017; 42:1113-1131. [PMID: 27878636 DOI: 10.1007/s00261-016-0976-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Gastrointestinal secretory tumors, or gastroenteropancreatic neuroendocrine tumors, encompass a wide array of endocrine cell tumors. The significance of these tumors lies in their ability to alter physiology through hormone production as we well as in their malignant potential. Functioning tumors may present earlier due to symptomatology; conversely, non-functioning tumors are often diagnosed late as they reach large sizes, causing symptoms secondary to local mass effect. Imaging aids in the diagnosis, staging, and prognosis and provides key information for presurgical planning. Although most of these tumors are sporadic, some are associated with important syndromes and associations, knowledge of which is critical for patient management. In this article, we provide an overview of secretory and neuroendocrine tumors of the GI tract and pancreas.
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32
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Laparoscopic surgery for pancreatic neoplasms: the European association for endoscopic surgery clinical consensus conference. Surg Endosc 2017; 31:2023-2041. [PMID: 28205034 DOI: 10.1007/s00464-017-5414-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 01/07/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Introduced more than 20 years ago, laparoscopic pancreatic surgery (LAPS) has not reached a uniform acceptance among HPB surgeons. As a result, there is no consensus regarding its use in patients with pancreatic neoplasms. This study, organized by the European Association for Endoscopic Surgery (EAES), aimed to develop consensus statements and clinical recommendations on the application of LAPS in these patients. METHODS An international panel of experts was selected based on their clinical and scientific expertise in laparoscopic and open pancreatic surgery. Each panelist performed a critical appraisal of the literature and prepared evidence-based statements assessed by other panelists during Delphi process. The statements were further discussed during a one-day face-to-face meeting followed by the second round of Delphi. Modified statements were presented at the plenary session of the 24th International Congress of the EAES in Amsterdam and in a web-based survey. RESULTS LAPS included laparoscopic distal pancreatectomy (LDP), pancreatoduodenectomy (LPD), enucleation, central pancreatectomy, and ultrasound. In general, LAPS was found to be safe, especially in experienced hands, and also advantageous over an open approach in terms of intraoperative blood loss, postoperative recovery, and quality of life. Eighty-five percent or higher proportion of responders agreed with the majority (69.5%) of statements. However, the evidence is predominantly based on retrospective case-control studies and systematic reviews of these studies, clearly affected by selection bias. Furthermore, no randomized controlled trials (RCTs) have been published to date, although four RCTs are currently underway in Europe. CONCLUSIONS LAPS is currently in its development and exploration stages, as defined by the international IDEAL framework for surgical innovation. LDP is feasible and safe, performed in many centers, while LPD is limited to few centers. RCTs and registry studies are essential to proceed with the assessment of LAPS.
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33
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Donegan D, Singh Ospina N, Rodriguez-Gutierrez R, Al-Hilli Z, Thompson GB, Clarke BL, Young WF. Long-term outcomes in patients with multiple endocrine neoplasia type 1 and pancreaticoduodenal neuroendocrine tumours. Clin Endocrinol (Oxf) 2017; 86:199-206. [PMID: 27770475 DOI: 10.1111/cen.13264] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/10/2016] [Accepted: 10/19/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND In patients with multiple endocrine neoplasia type 1 (MEN-1), pancreaticoduodenal (PD) neuroendocrine tumours (NETs) are associated with early mortality, yet the best treatment strategy remains uncertain. AIM To assess patient important outcomes (mortality and metastasis) of PD-NETs and predictors of outcomes in patients with MEN-1. METHODS Retrospective cohort of patients with MEN-1 who attended the Mayo Clinic, Rochester, MN from 1997 to 2014. RESULTS We identified 287 patients with MEN-1; 199 (69%) patients had 217 PD-NETs. Among those with a PD-NETs, 129 (65%) had surgery of which 90 (70%) had their primary surgery performed at Mayo Clinic. The median postoperative follow-up was 8 years during which 13 (14%) patients died. The mean (±standard deviation) age of death was 51 (±9) years. Tumour size, metastasis at surgery or tumour type were not predictive of mortality, but for every year older at surgery, the odds of metastasis increased by 6%. Surgery was not performed in 70 (35%) patients. Among those who were observed/medically managed without known metastatic disease, mean tumour growth was 0·02 cm/year (range, -0·13-0·4 cm/year). Four patients (7%) died at a median age of 77 (range, 51-89) years. CONCLUSION PD-NETs are common in patients with MEN-1 and are associated with early mortality even after surgical intervention. Active surveillance is a viable option in nonaggressive PD-NETs, although definitive factors identifying such patients are lacking. Therefore, counselling regarding risks and benefits of current treatment options remains integral to the care of patients with MEN-1.
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Affiliation(s)
- D Donegan
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - N Singh Ospina
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit in Endocrinology (KER-Endo), Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - R Rodriguez-Gutierrez
- Knowledge and Evaluation Research Unit in Endocrinology (KER-Endo), Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Department of Internal Medicine, University Hospital "Dr. Jose E. Gonzalez", Autonomous University of Nuevo Leon, Monterrey, Mexico
| | - Z Al-Hilli
- Division of Surgery, Mayo Clinic, Rochester, MN, USA
| | - G B Thompson
- Division of Surgery, Mayo Clinic, Rochester, MN, USA
| | - B L Clarke
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - W F Young
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
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Woltering EA, Voros BA, Beyer DT, Wang YZ, Thiagarajan R, Ryan P, Wright A, Ramirez RA, Ricks MJ, Boudreaux JP. Aggressive Surgical Approach to the Management of Neuroendocrine Tumors: A Report of 1,000 Surgical Cytoreductions by a Single Institution. J Am Coll Surg 2017; 224:434-447. [PMID: 28088602 DOI: 10.1016/j.jamcollsurg.2016.12.032] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 12/19/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Neuroendocrine tumors (NETs) are rare neoplasms. Our group has treated more than 2,000 NET patients and has performed more than 1,000 surgical cytoreductive procedures. STUDY DESIGN Records of 834 NET patients who underwent surgical cytoreduction at our institution were reviewed. Demographic information, intraoperative findings, extent of disease, complications, and survival rates were calculated. RESULTS Eight hundred patients underwent 1,001 cytoreductive operations. Sixty-five percent had small bowel primaries. One hundred and thirty-eight patients presented with an unknown primary site, which was localized intraoperatively in 89% of these cases. The intraoperative complication rate was 9%. The incidence of intraoperative carcinoid crisis was 1%. Mean ± SD operative time was 368 ± 146 minutes. Mean ± SD hospital stay was 9 ± 10 days. Minor postoperative complications occurred after 43% of procedures and major postoperative complications were noted after 19% of procedures. The 30-day postoperative mortality rate was 2%. Median overall survival (OS) for patients with pancreatic NETs was 124 months. The 5-, 10-, and 20-year OS rates for patients with pancreatic NETs were 67%, 51%, and 36%, respectively. The life expectancy difference (between OS and actuarial survival) after surgical cytoreduction for patients with pancreatic NETs was 16.6 years. Median OS for patients with small bowel NETs was 161 months. The 5-, 10-, and 20-year OS rates for patients with small bowel NETs were 84%, 67% and 31%, respectively. The life expectancy difference after surgical cytoreduction for patients with small bowel NETs was 11.7 years. CONCLUSIONS Surgical cytoreduction in NET patients has low morbidity and mortality rates and results in prolonged survival. We believe that surgical cytoreduction should play a major role in the care of patients with NETs.
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Affiliation(s)
| | - Brianne A Voros
- Louisiana State University Health Sciences Center, New Orleans, LA
| | - David T Beyer
- Louisiana State University Health Sciences Center, New Orleans, LA
| | - Yi-Zarn Wang
- Louisiana State University Health Sciences Center, New Orleans, LA
| | | | - Pamela Ryan
- Neuroendocrine Tumor Program, Ochsner Medical Center, Kenner, LA
| | - Anne Wright
- Louisiana State University Health Sciences Center, New Orleans, LA
| | - Robert A Ramirez
- Neuroendocrine Tumor Program, Ochsner Medical Center, Kenner, LA
| | - M Jennifer Ricks
- Neuroendocrine Tumor Program, Ochsner Medical Center, Kenner, LA
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Abstract
RATIONALE Laparoscopic total pancreatectomy is a complicated surgical procedure and rarely been reported. This study was conducted to investigate the safety and feasibility of laparoscopic total pancreatectomy. PATIENTS AND METHODS Three patients underwent laparoscopic total pancreatectomy between May 2014 and August 2015. We reviewed their general demographic data, perioperative details, and short-term outcomes. General morbidity was assessed using Clavien-Dindo classification and delayed gastric emptying (DGE) was evaluated by International Study Group of Pancreatic Surgery (ISGPS) definition. DIAGNOSIS AND OUTCOMES The indications for laparoscopic total pancreatectomy were intraductal papillary mucinous neoplasm (IPMN) (n = 2) and pancreatic neuroendocrine tumor (PNET) (n = 1). All patients underwent laparoscopic pylorus and spleen-preserving total pancreatectomy, the mean operative time was 490 minutes (range 450-540 minutes), the mean estimated blood loss was 266 mL (range 100-400 minutes); 2 patients suffered from postoperative complication. All the patients recovered uneventfully with conservative treatment and discharged with a mean hospital stay 18 days (range 8-24 days). The short-term (from 108 to 600 days) follow up demonstrated 3 patients had normal and consistent glycated hemoglobin (HbA1c) level with acceptable quality of life. LESSONS Laparoscopic total pancreatectomy is feasible and safe in selected patients and pylorus and spleen preserving technique should be considered. Further prospective randomized studies are needed to obtain a comprehensive understanding the role of laparoscopic technique in total pancreatectomy.
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Abstract
OBJECTIVE The aim of the study was to address the origin and natural history of malignant insulinoma. METHODS Retrospective review of medical records of patients diagnosed with insulinoma at Cedars-Sinai Medical Center between 2000 and 2015 was conducted. Hormonal expression in tumor specimens was examined by immunostaining. RESULTS All the 9 patients with malignant insulinoma (35% of 26 patients with insulinoma) already had liver metastasis at hypoglycemia presentation with bulky cumulative tumor burden. Six patients had de novo diagnosis, 2 had known metastatic nonfunctioning pancreatic neuroendocrine tumor, and 1 had a known pancreatic mass. Tumor grade at presentation was G1 in 4 patients, G2 in 4, and unknown in 1. Four patients died 2 to 32 months after presentation, all with extensive liver tumor involvement. Tumor expression of proinsulin and insulin was heterogeneous and overall infrequent. The proinsulin levels and proinsulin/insulin molar ratio in patients with malignant versus benign insulinoma were 334 versus 44 pmol/L and 2.1 versus 0.9, respectively. CONCLUSIONS Malignant insulinoma seems to arise from and behave like nonfunctioning pancreatic neuroendocrine tumor oncologically but with metachronous hyperinsulinemic hypoglycemia. High proinsulin levels and proinsulin/insulin molar ratio may suggest malignant insulinoma.
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National Rise of Primary Pancreatic Carcinoid Tumors: Comparison to Functional and Nonfunctional Pancreatic Neuroendocrine Tumors. J Am Coll Surg 2016; 224:1057-1064. [PMID: 27965134 DOI: 10.1016/j.jamcollsurg.2016.11.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/22/2016] [Accepted: 11/23/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND New guidelines recommend differentiating between carcinoid and pancreatic neuroendocrine tumors (PNETs) during clinical trials. However, little is known about the behavior and incidence of primary pancreatic carcinoid tumors. STUDY DESIGN We performed a retrospective cohort study using the National Cancer Data Base (NCDB) to identify adults with primary PNETs diagnosed between 2004 and 2013. The Kaplan-Meier method was used to evaluate overall survival, and multivariate Cox proportional hazards model was used to assess the hazard of death in resected patients. RESULTS Of 10,752 patients, 12.7% were diagnosed with carcinoid tumors, 84.7% with nonfunctional and 2.6% with functional PNETs. Although the number of functional PNETs has remained relatively constant over time, rates of nonfunctional and carcinoid tumors have risen dramatically. Only 36 (5.7%) carcinoid tumors were diagnosed in 2004; this increased to 497 (27.7%) in 2013. Overall survival was significantly longer for carcinoid compared with functional and nonfunctional tumors (log-rank p < 0.0001), with 5-year survival rates of 63.1%, 58.3%, and 52.6%, respectively. For patients having resection, overall survival further improved for carcinoid tumors relative to functional (log-rank p = 0.0011) and nonfunctional (log-rank p < 0.0001) tumors, but the survival difference between functional and nonfunctional tumors disappeared (log-rank p = 0.4579); 5-year survival rates were 89.2%, 76.6%, and 78.7%, respectively. On multivariate Cox regression of the resected cohort, mortality was significantly higher for patients with functional (hazard ratio [HR] 1.81) and nonfunctional (HR 1.40) PNETs compared with carcinoid tumors. CONCLUSIONS Primary pancreatic carcinoid tumors are increasingly being diagnosed. Differentiating PNET subtypes plays an important role in prognostication. Resection remains a critical component of care.
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Keck KJ, Maxwell JE, Menda Y, Bellizzi A, Dillon J, O'Dorisio TM, Howe JR. Identification of primary tumors in patients presenting with metastatic gastroenteropancreatic neuroendocrine tumors. Surgery 2016; 161:272-279. [PMID: 27863780 DOI: 10.1016/j.surg.2016.05.055] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with gastroenteropancreatic neuroendocrine tumors often present with metastases. Identification of the primary tumor is important for operative management, and therefore we sought to determine our success at identifying primary tumors with diagnostic testing and operative exploration. METHODS A clinical neuroendocrine tumor database was reviewed to identify patients presenting with metastases and primary tumor in situ. Results of radiologic, endoscopic, and operative procedures were evaluated to determine which correctly identified the primary tumor. RESULTS There were 197 patients presenting with metastases and unresected primaries, 134 who had an operation and 63 managed nonoperatively. Primaries were identified preoperatively in 168 (84%), at operative exploration in 7, and were not found in 22 patients. Computed tomography found 150/197 primary tumors, somatostatin-receptor scintigraphy 88/155, and endoscopy 43/107. The sensitivity of computed tomography surpassed scintigraphy (76% vs 57%, P < .01). The primary was removed in 130/134 (97%) patients, and hepatic debulking was performed in 67%. Median survival for operative patients with small bowel and pancreatic tumors was 145 and 71 months, respectively. CONCLUSION Imaging and endoscopy identified the primary tumor in most patients, and the majority of the others were found at exploration. Preoperative testing facilitated operative planning, allowing for resection of the primary and hepatic debulking in most patients.
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Affiliation(s)
- Kendall J Keck
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Jessica E Maxwell
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Yusuf Menda
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Andrew Bellizzi
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Joseph Dillon
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Thomas M O'Dorisio
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - James R Howe
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA.
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Wells SA. Progress in Endocrine Neoplasia. Clin Cancer Res 2016; 22:4981-4988. [PMID: 27742784 DOI: 10.1158/1078-0432.ccr-16-0384] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 08/24/2016] [Indexed: 01/17/2023]
Abstract
Most endocrine tumors are benign, and afflicted patients usually seek medical advice because of symptoms caused by too much, or too little, native hormone secretion or the impingement of their tumor on a vital structure. Malignant endocrine tumors represent a more serious problem, and patient cure often depends on early diagnosis and treatment. The recent development of novel molecular therapeutics holds great promise for the treatment of patients with locally advanced or metastatic endocrine cancer. In this CCR Focus, expert clinical investigators describe the molecular characteristics of various endocrine tumors and discuss the current status of diagnosis and treatment. Clin Cancer Res; 22(20); 4981-8. ©2016 AACR
See all articles in this CCR Focus section, "Endocrine Cancers Revising Paradigms".
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Affiliation(s)
- Samuel A Wells
- Genetics Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
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Lee HW, Chung JW, Kim YJ, Kwon KA, Kim EJ, Kim KK, Lee WK, Sym SJ. Synchronous Peripancreatic Lymph Node Gastrinoma and Gastric Neuroendocrine Tumor Type 2. Clin Endosc 2016; 49:483-487. [PMID: 27209642 PMCID: PMC5066414 DOI: 10.5946/ce.2016.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/07/2016] [Accepted: 04/25/2016] [Indexed: 11/30/2022] Open
Abstract
A 34-year-old man was referred to our hospital with gastric polypoid lesions and biopsy-confirmed neuroendocrine tumor (NET). Computed tomography (CT) revealed a 3×3.5×8-cm retroperitoneal mass behind the pancreas, with multiple hepatic metastases. His serum gastrin level was elevated to 1,396 pg/mL. We performed a wedge resection of the stomach, a right hemi-hepatectomy, and a retroperitoneal mass excision. After careful review of the clinical, radiological, histopathological, and immunohistochemical findings, peripancreatic gastrinoma, and synchronous gastric NET were ultimately diagnosed. We reviewed a CT scan that had been performed 6 years previously after surgery for a duodenal perforation. There was no evidence of gastric or hepatic lesions, but the retroperitoneal mass was present at the same site. Had gastrinoma been detected earlier, our patient could have been cured using less invasive treatment. This case demonstrates how important it is to consider Zollinger-Ellison syndrome in patients with a recurrent or aggressive ulcer.
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Affiliation(s)
- Hee Woo Lee
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jun-Won Chung
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Yoon Jae Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Kwang Ahn Kwon
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Eui Joo Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Keon Kuk Kim
- Department of Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Woon Ki Lee
- Department of Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Sun Jin Sym
- Department of Hematology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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Thiels CA, Bergquist JR, Laan DV, Croome KP, Smoot RL, Nagorney DM, Thompson GB, Kendrick ML, Farnell MB, Truty MJ. Outcomes of Pancreaticoduodenectomy for Pancreatic Neuroendocrine Tumors: Are Combined Procedures Justified? J Gastrointest Surg 2016; 20:891-8. [PMID: 26925796 DOI: 10.1007/s11605-016-3102-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/02/2016] [Indexed: 01/31/2023]
Abstract
Efficacy and outcomes of resection for pancreatic neuroendocrine tumors (pNET) are well established; specific data on outcomes for pancreaticoduodenectomy (PD), either alone or with combined procedures, are limited. A retrospective review of PDs for pNET (1998-2014) at our institution was conducted. Patients were categorized into standard PD (SPD) alone or combined PD (CPD) defined as patients undergoing concurrent vascular reconstruction or additional organ resection for curative intent. Kaplan-Meier survival analyses were performed. PD for pNET was performed for 95 patients. Tumors were functional in 11 patients (9 %). Twenty-six patients (28 %) underwent CPD. The 30/90-day mortality was 1.1/5.3 % respectively and similar between SPD and CPD (p = 0.61/p = 0.24). Five-year overall survival after PD for pNET was 85.1/71.9 % and similar between SPD/CPD groups (p = 0.17). Recurrence-free and overall survival for low-grade tumors was 74.7/93.9 % at 5 years compared to only 14.8/49.7 % for high-grade tumors (p < 0.001) and not predicted by extent of resection (SPD/CPD, respectively). PD with or without concurrent resection provides an acceptable, perioperative and long-term oncologic, outcome for pNET. CPD is justified treatment modality, particularly for patients with low-grade tumors. The need for combinatorial procedures during PD is not contraindication alone for otherwise resectable patients with pNET.
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Affiliation(s)
- Cornelius A Thiels
- Department of Surgery, Mayo Clinic Rochester, 200 First St. Southwest, Rochester, MN, 55905, USA.,Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - John R Bergquist
- Department of Surgery, Mayo Clinic Rochester, 200 First St. Southwest, Rochester, MN, 55905, USA.,Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Danuel V Laan
- Department of Surgery, Mayo Clinic Rochester, 200 First St. Southwest, Rochester, MN, 55905, USA
| | | | - Rory L Smoot
- Department of Surgery, Mayo Clinic Rochester, 200 First St. Southwest, Rochester, MN, 55905, USA
| | - David M Nagorney
- Department of Surgery, Mayo Clinic Rochester, 200 First St. Southwest, Rochester, MN, 55905, USA
| | - Geoffrey B Thompson
- Department of Surgery, Mayo Clinic Rochester, 200 First St. Southwest, Rochester, MN, 55905, USA
| | - Michael L Kendrick
- Department of Surgery, Mayo Clinic Rochester, 200 First St. Southwest, Rochester, MN, 55905, USA
| | - Michael B Farnell
- Department of Surgery, Mayo Clinic Rochester, 200 First St. Southwest, Rochester, MN, 55905, USA
| | - Mark J Truty
- Department of Surgery, Mayo Clinic Rochester, 200 First St. Southwest, Rochester, MN, 55905, USA.
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Chiruvella A, Kooby DA. Surgical Management of Pancreatic Neuroendocrine Tumors. Surg Oncol Clin N Am 2016; 25:401-21. [PMID: 27013372 DOI: 10.1016/j.soc.2015.12.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Folkert IW, Hernandez P, Roses RE. Multidisciplinary management of nonfunctional neuroendocrine tumor of the pancreas. World J Gastroenterol 2016; 22:3105-3116. [PMID: 27003988 PMCID: PMC4789986 DOI: 10.3748/wjg.v22.i11.3105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/05/2016] [Accepted: 01/11/2016] [Indexed: 02/06/2023] Open
Abstract
Pancreatic neuroendocrine tumors (PNETs) are a rare and diverse group of tumors; nonfunctional (NF) PNETs account for the majority of cases. Most patients with NF-PNETs have metastatic disease at the time of presentation. A variety of treatment modalities exist, including medical, liver directed, and surgical treatments. Aggressive surgical management is associated with prolonged survival, however available data are limited by selection bias and the frequent combination of PNETs with carcinoid tumors. Although few patients with metastatic disease will be cured, application of currently available therapies in a multidisciplinary setting can lead to excellent outcomes with prolonged patient survival.
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Abstract
Islet cell tumors of the pancreas, also known as pancreatic neuroendocrine tumors, constitute less than 5% of pancreatic tumors, and 7% of all neuroendocrine tumors. Most are non-functional, and patients often present with metastatic disease. Functional tumors present with distinct clinical syndromes. Accurate staging is critical as surgery is both the cornerstone of treatment, and the only hope for cure. Medical management involves treating the manifestations of hormonal excess, and using somatastatin analogues when appropriate. Systemic chemotherapy, targeted molecular therapy, and peptide receptor radiotherapy may be used for refractory disease in lieu of or as an adjunct to surgery.
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Affiliation(s)
- Sunil Amin
- Division of Gastroenterology, Department of Medicine Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1069, New York, NY 10029, USA
| | - Michelle Kang Kim
- Division of Gastroenterology, Department of Medicine Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1069, New York, NY 10029, USA.
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Jilesen APJ, van Eijck CHJ, in't Hof KH, van Dieren S, Gouma DJ, van Dijkum EJMN. Postoperative Complications, In-Hospital Mortality and 5-Year Survival After Surgical Resection for Patients with a Pancreatic Neuroendocrine Tumor: A Systematic Review. World J Surg 2016; 40:729-48. [PMID: 26661846 PMCID: PMC4746219 DOI: 10.1007/s00268-015-3328-6] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Studies on postoperative complications and survival in patients with pancreatic neuroendocrine tumors (pNET) are sparse and randomized controlled trials are not available. We reviewed all studies on postoperative complications and survival after resection of pNET. A systematic search was performed in the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE from 2000-2013. Inclusion criteria were studies of resected pNET, which described postoperative complications separately for each surgical procedure and/or 5-year survival after resection. Prospective and retrospective studies were pooled separately and overall pooled if heterogeneity was below 75%. The random-effect model was used. Overall, 2643 studies were identified and after full-text analysis 62 studies were included. Pancreatic fistula (PF) rate of the prospective studies after tumor enucleation was 45%; PF-rates after distal pancreatectomy, pancreatoduodenectomy, or central pancreatectomy were, respectively, 14-14-58%. Delayed gastric emptying rates were, respectively, 5-5-18-16%. Postoperative hemorrhage rates were, respectively, 6-1-7-4%. In-hospital mortality rates were, respectively, 3-4-6-4%. The 5-year overall survival (OS) and disease-specific survival (DSS) of resected pNET without synchronous resected liver metastases were, respectively, 85-93%. Heterogeneity between included studies on 5-year OS in patients with synchronous resected liver metastases was too high to pool all studies. The 5-year DSS in patients with liver metastases was 80%. Morbidity after pancreatic resection for pNET was mainly caused by PF. Liver resection in patients with liver metastases seems to have a positive effect on DSS. To reduce heterogeneity, ISGPS criteria and uniform patient groups should be used in the analysis of postoperative outcome and survival.
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Affiliation(s)
- Anneke P J Jilesen
- Department of Surgery, Academic Medical Center, Meibergdreef 9, P. O. Box 22660, 1105 AZ, Amsterdam, The Netherlands.
| | | | - K H in't Hof
- Department of Surgery, Academic Medical Center, Meibergdreef 9, P. O. Box 22660, 1105 AZ, Amsterdam, The Netherlands
| | - S van Dieren
- Department of Methodology and Statistics Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands
| | - Dirk J Gouma
- Department of Surgery, Academic Medical Center, Meibergdreef 9, P. O. Box 22660, 1105 AZ, Amsterdam, The Netherlands
| | - Els J M Nieveen van Dijkum
- Department of Surgery, Academic Medical Center, Meibergdreef 9, P. O. Box 22660, 1105 AZ, Amsterdam, The Netherlands
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Hasselgren K, Sandström P, Gasslander T, Björnsson B. Multivisceral Resection in Patients with Advanced Abdominal Tumors. Scand J Surg 2016; 105:147-52. [PMID: 26929293 DOI: 10.1177/1457496915622128] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 10/05/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIM Multivisceral resection for advanced tumors can result in prolonged survival but may also increase the risk of postoperative morbidity and mortality. The primary aim of this study was to investigate whether extensive resections increase the severity of postoperative complications. MATERIALS AND METHODS A retrospective study was conducted between 2009 and 2014 at the Linköping University Hospital surgical department. All patients with a confirmed or presumed malignant disease who underwent a non-standardized surgical procedure requiring a multivisceral resection were included. The primary endpoint was 90-day complications according to the Clavien-Dindo score. RESULTS Forty-eight patients were included, with an age range of 17-77 years. A median of three organs was resected. The most common diagnoses were neuroendocrine tumor (n = 8), gastric cancer (n = 7), and gastrointestinal stromal tumor (n = 6). One patient died during surgery. Complications ⩾ grade 3b according to Clavien-Dindo score occurred in 10 patients. R0 resection was achieved in 32 patients. No correlation was observed between the number of anastomoses, perioperative blood loss, operative time, and complications. Only postoperative blood transfusion was correlated with severe complications (p = 0.046); however, a tendency toward more complications with an increasing number of resected organs was observed (p = 0.06). CONCLUSION Multivisceral resection can result in R0, potentially curing patients with advanced tumors. Here, no correlation between extensive resections and complications was observed. Only postoperative blood transfusion was correlated with severe complications.
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Affiliation(s)
- K Hasselgren
- Department of Surgery, Linköping University, Linköping, Sweden Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - P Sandström
- Department of Surgery, Linköping University, Linköping, Sweden Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - T Gasslander
- Department of Surgery, Linköping University, Linköping, Sweden Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - B Björnsson
- Department of Surgery, Linköping University, Linköping, Sweden Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Sakr M. Pancreatic Neuroendocrine Tumors. HEAD AND NECK AND ENDOCRINE SURGERY 2016:367-382. [DOI: 10.1007/978-3-319-27532-1_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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Lee L, Igarashi H, Fujimori N, Hijioka M, Kawabe K, Oda Y, Jensen RT, Ito T. Long-term outcomes and prognostic factors in 78 Japanese patients with advanced pancreatic neuroendocrine neoplasms: a single-center retrospective study. Jpn J Clin Oncol 2015; 45:1131-1138. [PMID: 26378090 PMCID: PMC4668751 DOI: 10.1093/jjco/hyv143] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/25/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Despite an increase in the number of Japanese patients with pancreatic neuroendocrine neoplasms, long-term outcomes and prognostic factors, especially for those with advanced disease, remain unclear. METHODS We retrospectively reviewed the medical records of 78 patients with unresectable pancreatic neuroendocrine neoplasms treated at our hospital from January 1987 to March 2015. Survival analyses were performed using Kaplan-Meier methods. Prognostic significance of several clinicopathological factors were analyzed by univariate and multivariate analyses using a Cox regression model. RESULTS Median overall survivals of pancreatic neuroendocrine tumor (n = 64) and pancreatic neuroendocrine carcinoma (n = 14) were 83.7 and 9.1 months, respectively (hazard ratio: 0.02, 95% confidence interval: 0.01-0.08, P < 0.001). Although no significant differences were observed using a Ki-67 cut-off value of 2% (hazard ratio: 0.46, 95% confidence interval: 0.16-1.13, P = 0.0989), a Ki-67 cut-off of 10% was a significant predictor in patients with pancreatic neuroendocrine tumor (hazard ratio: 9.95, 95% confidence interval, 3.01-32.97, P < 0.001). Treatment after the advent of targeted therapy (hazard ratio: 0.07, 95% confidence interval: 0.03-0.19, P < 0.001) and the presence of bone metastases (hazard ratio: 4.38, 95% confidence interval: 1.42-11.29, P = 0.013) were significant prognostic factors in patients with pancreatic neuroendocrine tumor evaluated by univariate analysis. Multivariate analysis also revealed that a Ki-67 index ≥10% (hazard ratio: 38.8, 95% confidence interval: 8.42-226.62, P < 0.001), approval of targeted therapy (hazard ratio: 0.02, 95% confidence interval: 0.00-0.11, P < 0.001) and bone metastases (hazard ratio: 5.56, 95% confidence interval: 1.10-24.00, P = 0.039) were independent prognostic factors. CONCLUSIONS We elucidated the long-term outcomes and prognostic factors in Japanese patients with advanced pancreatic neuroendocrine neoplasms.
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Affiliation(s)
- Lingaku Lee
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Hisato Igarashi
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Nao Fujimori
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Masayuki Hijioka
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Ken Kawabe
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Robert T Jensen
- Digestive Diseases Branch, National Institutes of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Tetsuhide Ito
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka
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Shin WY, Lee KY, Ahn SI, Park SY, Park KM. Cutaneous metastasis as an initial presentation of a non-functioning pancreatic neuroendocrine tumor. World J Gastroenterol 2015; 21:9822-9826. [PMID: 26361431 PMCID: PMC4562968 DOI: 10.3748/wjg.v21.i33.9822] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 05/26/2015] [Accepted: 07/08/2015] [Indexed: 02/06/2023] Open
Abstract
Non-functioning pancreatic neuroendocrine tumors (NF-PNETs) are rare tumors that account for 2% of all pancreatic malignancy. About 60% of NF-PNETs present distant metastases and usually hepatic metastases. However, cutaneous metastases are very rare. Herein, we report our experience with a 60-year-old male who visited our outpatient clinic with a mass on his left hip. An abdominal computerized tomography scan demonstrated not only a left hip mass and an enlarged left inguinal lymph node, but also a huge heterogeneous enhancing mass on the pancreas. Initially, we removed the metastatic lesions, which was a small cell neuroendocrine carcinoma with 50% of the Ki-67 index in the histopathological report. After 3 wk, we performed a total pancreatectomy and a total gastrectomy. Four weeks after the 1st operation, we detected a recurrence at the operative bed on his left hip, and subsequently removed the recurring mass. The patient was receiving chemotherapy based on etoposide and cisplatin treatment.
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50
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Tran TB, Dua MM, Spain DA, Visser BC, Norton JA, Poultsides GA. Hepato-pancreatectomy: how morbid? Results from the national surgical quality improvement project. HPB (Oxford) 2015; 17:763-9. [PMID: 26058463 PMCID: PMC4557649 DOI: 10.1111/hpb.12426] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 04/13/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Simultaneous resection of both the liver and the pancreas carries significant complexity. The objective of this study was to investigate peri-operative outcomes after a synchronous hepatectomy and pancreatectomy (SHP). METHODS The American College of Surgeons National Surgical Quality Improvement Project database was queried to identify patients who underwent SHP. Resections were categorized as '< hemihepatectomy', '≥ hemihepatectomy' (hemihepatectomy and trisectionectomy), 'PD' (pancreaticoduodenectomy and total pancreatectomy) and 'distal' (distal pancreatectomy and enucleation). RESULTS From 2005 to 2013, 480 patients underwent SHP. Patients were stratified based on the extent of resection: '< hemihepatectomy + distal (n = 224)', '≥ hemihepatectomy + distal' (n = 49), '< hemihepatectomy + PD' (n = 83) and '≥ hemihepatectomy + PD' (n = 24). Although the first three groups had a reasonable and comparable safety profile (morbidity 33-51% and mortality 0-6.6%), the '≥ hemihepatectomy + PD' group was associated with an 87.5% morbidity (organ space infection 58.3%, re-intubation 12.5%, reoperation 25% and septic shock 25%), 8.3% 30-day mortality and 18.2% in-hospital mortality. CONCLUSIONS A synchronous hemihepatectomy (or trisectionectomy) with PD remains a highly morbid combination and should be reserved for patients who have undergone extremely cautious selection.
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Affiliation(s)
- Thuy B Tran
- Department of Surgery, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Monica M Dua
- Department of Surgery, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - David A Spain
- Department of Surgery, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Brendan C Visser
- Department of Surgery, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Jeffrey A Norton
- Department of Surgery, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - George A Poultsides
- Department of Surgery, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
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