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Comparison of Oncological and Surgical Outcomes Between Formal Pancreatic Resections and Parenchyma-Sparing
Antonio Pea1, Lulu Tanno2, Taina Nykänen3
1Department of Surgery, Istituto Pancreas, Ospedale Universitario Integrato Verona, Verona, Italy.
Abstract:
Pancreatic neuroendocrine tumors (PanNETs) are rare tumors but incidence is increasing. An increasing number of these tumors are diagnosed incidentally when they are small (<2 cm) and when patients are asymptomatic. The European Neuroendocrine Tumor Society (ENETS) recommends conservative watch and wait policy for these patients. However, best surgical approach (parenchyma-sparing or formal oncological resection) for these small tumors when surgery is indicated is currently unknown. Parenchyma-sparing resections such as enucleation is associated with higher risk of post-operative morbidity compared to formal oncological resections. They are also be associated with potentially inadequate surgical margin clearance and with lack of lymphadenectomy for full pathological staging. Method: This study is a retrospective study and the aim is to analyze pre-operative clinical predictors of nodal metastases for small PanNETs to identify which patients are at a lower risk of lymph node metastases and are therefore suitable for parenchyma-sparing resection. Conclusion: The primary endpoint of this study is to determine if pre-operative clinical predictors such as tumor size are associated with lymph node involvement in small PanNETs.
Insights
For small pancreatic neuroendocrine tumors (PanNETs), this study identifies predictors of lymph node metastasis. This research aids in selecting patients suitable for less invasive parenchyma-sparing surgery.
Area of Science:
- Oncology
- Gastroenterology
- Surgical Oncology
Background:
- Pancreatic neuroendocrine tumors (PanNETs) are increasingly diagnosed, often incidentally as small, asymptomatic tumors.
- Current European Neuroendocrine Tumor Society (ENETS) guidelines suggest a 'watch and wait' approach for these cases.
- The optimal surgical strategy for small PanNETs requiring resection remains unclear, with parenchyma-sparing options posing risks of morbidity and inadequate staging.
Purpose of the Study:
- To identify pre-operative clinical predictors of lymph node metastases in small PanNETs (<2 cm).
- To determine which patients with small PanNETs are candidates for parenchyma-sparing resection by assessing lymph node involvement risk.
Main Methods:
- Retrospective study analyzing pre-operative data.
- Focus on identifying clinical predictors, including tumor size, associated with lymph node metastasis in small PanNETs.
Main Results:
- Analysis of pre-operative clinical predictors for nodal metastases in small PanNETs.
- Evaluation of the association between tumor size and lymph node involvement.
Conclusions:
- The study aims to establish criteria for selecting patients with small PanNETs for parenchyma-sparing resection.
- Identifying low-risk patients for lymph node metastasis is crucial for surgical decision-making.
