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Long-term Outcomes of Parenchyma-sparing and Oncologic Resections in Patients With Nonfunctional Pancreatic Neuroendocrine Tumors <3 cm in a Large Multicenter Cohort
Annals of Surgery ( IF 9 ) Pub Date : 2022-09-01 , DOI: 10.1097/sla.0000000000005559
Louisa Bolm 1 , Martina Nebbia 1 , Alice C Wei 2 , Amer H Zureikat 3 , Carlos Fernández-Del Castillo 1 , Jian Zheng 3 , Alessandra Pulvirenti 2 , Ammar A Javed 4 , Yurie Sekigami 1 , Natalie Petruch 1 , Motaz Qadan 1 , Keith D Lillemoe 1 , Jin He 4 , Cristina R Ferrone 1 ,
Affiliation  

Introduction: 

The role of parenchyma-sparing resections (PSR) and lymph node dissection in small (<3 cm) nonfunctional pancreatic neuroendocrine tumors (PNET) is unlikely to be studied in a prospective randomized clinical trial. By combining data from 4 high-volume pancreatic centers we compared postoperative and long-term outcomes of patients who underwent PSR with patients who underwent oncologic resections.

Methods: 

Retrospective review of prospectively collected clinicopathologic data of patients who underwent pancreatectomy between 2000 and 2021 was collected from 4 high-volume institutions. PSR and lymph node-sparing resections (enucleation and central pancreatectomy) were compared to those who underwent oncologic resections with lymphadenectomy (pancreaticoduodenectomy, distal pancreatectomy). Statistical testing was performed using χ2 test and t test, survival estimates with Kaplan-Meier method and multivariate analysis using Cox proportional hazard model.

Results: 

Of 810 patients with small sporadic nonfunctional PNETs, 121 (14.9%) had enucleations, 100 (12.3%) had central pancreatectomies, and 589 (72.7%) patients underwent oncologic resections. The median age was 59 years and 48.2% were female with a median tumor size of 2.5 cm. After case-control matching for tumor size, 221 patients were selected in each group. Patients with PSR were more likely to undergo minimally invasive operations (32.6% vs 13.6%, P<0.001), had less intraoperative blood loss (358 vs 511 ml, P<0.001) and had shorter operative times (180 vs 330 minutes, P<0.001) than patients undergoing oncologic resections. While the mean number of lymph nodes harvested was lower for PSR (n=1.4 vs n=9.9, P<0.001), the mean number of positive lymph nodes was equivalent to oncologic resections (n=1.1 vs n=0.9, P=0.808). Although the rate of all postoperative complications was similar for PSR and oncologic resections (38.5% vs 48.2%, P=0.090), it was higher for central pancreatectomies (38.5% vs 56.6%, P=0.003). Long-term median disease-free survival (190.5 vs 195.2 months, P=0.506) and overall survival (197.9 vs 192.6 months, P=0.372) were comparable. Of the 810 patients 136 (16.7%) had no lymph nodes resected. These patients experienced less blood loss, shorter operations (P<0.001), and lower postoperative complication rates as compared to patients who had lymphadenectomies (39.7% vs 56.9%, P=0.008). Median disease-free survival (197.1 vs 191.9 months, P=0.837) and overall survival (200 vs 195.1 months, P=0.827) were similar for patients with no lymph nodes resected and patients with negative lymph nodes (N0) after lymphadenectomy.

Conclusion: 

In small <3 cm nonfunctional PNETs, PSRs and lymph node-sparing resections are associated with lower blood loss, shorter operative times, and lower complication rates when compared to oncologic resections, and have similar long-term oncologic outcomes.



中文翻译:

大型多中心队列中小于 3 cm 的非功能性胰腺神经内分泌肿瘤患者的实质保留和肿瘤切除的长期结果

介绍: 

前瞻性随机临床试验不太可能研究保留实质切除术(PSR)和淋巴结清扫术在小型(<3 cm)非功能性胰腺神经内分泌肿瘤(PNET)中的作用。通过结合来自 4 个大容量胰腺中心的数据,我们比较了接受 PSR 的患者与接受肿瘤切除术的患者的术后和长期结果。

方法: 

对 2000 年至 2021 年间接受胰腺切除术的患者前瞻性收集的临床病理数据进行回顾性分析,收集自 4 个大容量机构。将 PSR 和淋巴结保留切除术(摘除术和中央胰腺切除术)与接受肿瘤切除术和淋巴结切除术(胰十二指肠切除术、远端胰腺切除术)的患者进行比较。采用χ 2检验和t检验进行统计检验,采用Kaplan-Meier法进行生存估计,并采用Cox比例风险模型进行多变量分析。

结果: 

在 810 名散发性小无功能性 PNET 患者中,121 名(14.9%)接受了摘除术,100 名(12.3%)接受了中央胰腺切除术,589 名(72.7%)名患者接受了肿瘤切除术。中位年龄为 59 岁,48.2% 为女性,肿瘤中位大小为 2.5 cm。根据肿瘤大小进行病例对照匹配后,每组共选择221例患者。PSR患者接受微创手术的可能性更高(32.6% vs 13.6%,P <0.001),术中失血量较少(358 vs 511 ml,P <0.001),手术时间较短(180 vs 330 分钟,P <0.001)高于接受肿瘤切除的患者。虽然 PSR 采集的淋巴结平均数量较低(n=1.4 vs n=9.9,P <0.001),但阳性淋巴结的平均数量与肿瘤切除相当(n=1.1 vs n=0.9,P =0.808 ) )。尽管 PSR 和肿瘤切除术的所有术后并发症发生率相似(38.5% vs 48.2%,P = 0.090),但中央胰腺切除术的并发症发生率较高(38.5% vs 56.6%,P = 0.003)。长期中位无病生存期(190.5 个月 vs 195.2 个月,P = 0.506)和总生存期(197.9 个月 vs 192.6 个月,P = 0.372)具有可比性。810 名患者中有 136 名(16.7%)没有切除淋巴结。与接受淋巴结清扫术的患者相比,这些患者失血量较少,手术时间较短(P <0.001),术后并发症发生率较低(39.7% vs 56.9%, P = 0.008)。未切除淋巴结的患者和淋巴结切除后淋巴结阴性 (N0) 的患者的中位无病生存期(197.1 个月 vs 191.9 个月, P = 0.837)和总生存期(200 个月 vs 195.1 个月,P = 0.827)相似。

结论: 

在小于 3 cm 的小型非功能性 PNET 中,与肿瘤切除相比,PSR 和保留淋巴结切除术与较低的失血量、较短的手术时间和较低的并发症发生率相关,并且具有相似的长期肿瘤学结果。

更新日期:2022-08-16
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