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Active Surveillance versus Surgery of Nonfunctioning Pancreatic Neuroendocrine Neoplasms ≤2 cm in MEN1 Patients
Stefano Partelli1, Domenico Tamburrino, Caroline Lopez
1Pancreatic Surgery Unit, Department of Internal Medicine, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.
Background:
The aim of this study was to evaluate the efficacy of conservative treatment for nonfunctioning pancreatic neuroendocrine neoplasms (NF-PNEN) ≤2 cm in multiple endocrine neoplasia type 1 (MEN1)-affected patients compared with surgical treatment.
Methods:
The databases of 4 tertiary referral institutions (San Raffaele Scientific Institute, Milan; Philipps-Universität Marburg, Marburg; University of Padua, Padua; Royal Free Hospital, London) were analyzed. A comparison of conservative management and surgery at initial diagnosis of NF-PNEN ≤2 cm between 1997 and 2013 was performed.
Results:
Overall, 27 patients (45%) underwent up-front surgery and 33 patients (55%) were followed up after the initial diagnosis. A higher proportion of patients in the surgery group were female (70 vs. 33%, p = 0.004). Patients were mainly operated on in the period 1997-2007 as compared with the period 2008-2013 (n = 17; 63 vs. 37%; p = 0.040). The rate of multifocal tumors was higher in the surgery group (n = 24; 89%) than in the 'no surgery' group (n = 22; 67%; p = 0.043). After a median follow-up of 126 months, 1 patient deceased due to postoperative complications within 30 days after surgery. The 5-, 10-, and 15-year progression-free survival (PFS) rates were 63, 39, and 10%, respectively. The median PFS was similar in the two groups. Overall, 13 patients (32.5%) were operated on after initial surgical or conservative treatment. The majority of the surgically treated patients had stage 1 (77.5%), T1 (77.5%), and G1 (85%) tumors.
Conclusions:
NF-PNEN ≤2 cm in MEN1 patients are indolent neoplasms posing a low oncological risk. Surgical treatment of these tumors at initial diagnosis is rarely justified in favor of conservative treatment.
Insights
Conservative treatment is effective for nonfunctioning pancreatic neuroendocrine neoplasms (NF-PNEN) ≤2 cm in multiple endocrine neoplasia type 1 (MEN1) patients. These indolent tumors pose a low oncological risk, making surgery rarely necessary at initial diagnosis.
Area of Science:
- Endocrinology
- Surgical Oncology
- Oncology
Background:
- Multiple endocrine neoplasia type 1 (MEN1) is a genetic disorder associated with a predisposition to developing neuroendocrine tumors.
- Nonfunctioning pancreatic neuroendocrine neoplasms (NF-PNEN) are tumors of the pancreas that do not produce excess hormones.
- NF-PNENs ≤2 cm in MEN1 patients represent a specific clinical challenge regarding optimal management strategy.
Purpose of the Study:
- To compare the efficacy of conservative management versus surgical treatment for NF-PNENs ≤2 cm in MEN1 patients.
- To evaluate the oncological outcomes and progression-free survival in this patient cohort.
- To determine the appropriate treatment approach for small, nonfunctioning pancreatic neuroendocrine neoplasms in the context of MEN1.
Main Methods:
- Retrospective analysis of patient data from four tertiary referral institutions.
- Comparison of conservative management and up-front surgery for NF-PNENs ≤2 cm diagnosed between 1997 and 2013.
- Assessment of progression-free survival and other clinical outcomes.
Main Results:
- A total of 60 patients were analyzed, with 27 undergoing surgery and 33 managed conservatively.
- The median progression-free survival was similar between the conservative and surgical groups.
- A significant proportion of surgically treated patients had early-stage (Stage 1, T1, G1) tumors, suggesting potential over-treatment in some cases.
Conclusions:
- NF-PNENs ≤2 cm in MEN1 patients are indolent neoplasms with a low oncological risk.
- Conservative management is a viable and often preferred strategy, showing comparable outcomes to surgery.
- Surgical intervention at initial diagnosis for these specific tumors is rarely justified, supporting a watchful waiting approach.
