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Application of End-to-end Anastomosis in Robotic Central Pancreatectomy
Published on: June 2, 2018
Indications and outcome of surgery for small nonfunctioning pancreatic neuroendocrine neoplasms (≤2 cm)
Fabiola A Bechtiger1, Anna Nießen2, Ulf Hinz1
1Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany.
Objective:
Optimal treatment strategies for small (≤2 cm) nonfunctioning pancreatic neuroendocrine neoplasms are still subject to discussion. The aim of this study was to analyze real-world data of patients with pancreatic neuroendocrine neoplasms ≤2 cm regarding the indications for surgery and long-term postresection survival.
Methods:
All patients undergoing surgery for nonfunctioning pancreatic neuroendocrine neoplasms ≤2 cm between 2003 and 2023 were analyzed. Indications for surgery, clinicopathologic parameters, and long-term survival were assessed. Differences between pancreatic neuroendocrine neoplasms <1 cm and 1-2 cm were evaluated.
Results:
Of a total of 806 resected pancreatic neuroendocrine neoplasms, 237 patients had a lesion ≤2 cm (29.4%), 85 of which were smaller than 1 cm. The 3 most common indications for surgery for pancreatic neuroendocrine neoplasms ≤2 cm were either suspicion of a non-neuroendocrine neoplasm malignancy (55.2%), suspicion of neuroendocrine tumor (25.9%), or obstruction of the pancreatic duct (9.4%). Tumor differentiation was 84% G1, 15% G2, and 1.3% G3. Noticeably, 5.1% of pancreatic neuroendocrine neoplasms ≤2 cm had lymph node metastasis (pN1). Five patients with a small pancreatic neuroendocrine neoplasm developed distant metastasis (pM1). The 10-year overall survival was 86.9% for <1 cm and 84.5% for 1-2 cm (P = .964). 10-year disease-free survival was 83.1% in patients with a pancreatic neuroendocrine neoplasms <1 cm and 81.1% for pancreatic neuroendocrine neoplasms 1-2 cm (P = .784).
Conclusion:
Surgical treatment of small (≤2 cm) pancreatic neuroendocrine neoplasms provides excellent long-term survival. Since even small pancreatic neuroendocrine neoplasms can develop lymph node and distant metastases, treatment decisions should not be determined on the basis of tumor size alone.
Insights
Surgical treatment for small pancreatic neuroendocrine neoplasms (≤2 cm) offers excellent long-term survival. However, size alone is insufficient for treatment decisions, as these tumors can metastasize.
Area of Science:
- Oncology
- Gastroenterology
- Surgical Oncology
Background:
- Optimal management strategies for small (≤2 cm) nonfunctioning pancreatic neuroendocrine neoplasms (PNENs) remain under discussion.
- Real-world data analysis is crucial for understanding treatment outcomes in these cases.
Purpose of the Study:
- To analyze real-world data on patients with PNENs ≤2 cm.
- To evaluate indications for surgery and long-term survival after resection.
Main Methods:
- Retrospective analysis of patients who underwent surgery for PNENs ≤2 cm (2003-2023).
- Assessment of surgical indications, clinicopathologic parameters, and long-term survival.
- Comparative evaluation between PNENs <1 cm and 1-2 cm.
Main Results:
- Of 806 resected PNENs, 237 were ≤2 cm. Common indications for surgery included suspicion of malignancy (55.2%) and duct obstruction (9.4%).
- 5.1% of small PNENs showed lymph node metastasis (pN1), and 5 patients developed distant metastasis (pM1).
- 10-year overall survival was 86.9% (<1 cm) vs. 84.5% (1-2 cm), and disease-free survival was 83.1% vs. 81.1%, respectively, with no significant difference (P > .78).
Conclusions:
- Surgical intervention for small PNENs yields excellent long-term survival rates.
- Treatment decisions for small PNENs should consider factors beyond tumor size due to metastatic potential.
- Further research into risk stratification for small PNENs is warranted.
