Anne Worth, Rasa Zarnegar, Thomas J Fahey, Brendan M Finnerty
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引用次数: 0
Abstract
Background: Current guidelines for the management of pancreatic neuroendocrine tumors consider observation of localized pancreatic neuroendocrine tumors <1 cm, but it remains unclear if larger tumors have a propensity to spread. We aimed to assess the safety of delayed surgery on larger tumors and determine candidacy of a clinically relevant subgroup for nonoperative management.
Methods: Resected M0, T1 (<2 cm), T2 (2-4 cm), and T3 (>4 cm) pancreatic neuroendocrine tumors from the Surveillance, Epidemiology, and End Results program from 2010 to 2022 were included. The interval from diagnosis to surgery and disease-specific survival were analyzed. National Cancer Database patients were then reviewed to assess the effect of surgical delay on incidence of pathologic upstaging and overall survival.
Results: Overall, 4,898 and 9,072 patients from the Surveillance, Epidemiology, and End Results program and the National Cancer Database were included, respectively. Multivariable analysis demonstrated no impact of 3- to 6-month or 6- to 12-month delay to surgery on disease-specific survival (P = .44, .74) or overall survival (P = .51, .39). Subgroup analysis of T2, G1 nonfunctional tumors (Surveillance, Epidemiology, and End Results, n = 988; National Cancer Database, n = 1,645) demonstrated no difference in disease-specific survival (P = .28, .23), overall survival (P = .97, .77), or odds of upstaging (P = .41, .09) with delay to surgery. T2 subgroup patients undergoing nonoperative management (National Cancer Database, n = 350) demonstrated decreased overall survival when compared with surgical treatment on multivariate analysis (hazard ratio, 2.32; 95% confidence interval, 1.55-3.48; P < .01).
Conclusion: Delayed surgery is safe for localized pancreatic neuroendocrine tumors without evidence of metastasis, and necessary time should be taken after diagnosis to optimize modifiable risk factors that impact survival. Expanding nonoperative management to patients with tumors >2 cm should be approached cautiously due to the association of nonoperative management with worse overall survival.
期刊介绍：
For 66 years, Surgery has published practical, authoritative information about procedures, clinical advances, and major trends shaping general surgery. Each issue features original scientific contributions and clinical reports. Peer-reviewed articles cover topics in oncology, trauma, gastrointestinal, vascular, and transplantation surgery. The journal also publishes papers from the meetings of its sponsoring societies, the Society of University Surgeons, the Central Surgical Association, and the American Association of Endocrine Surgeons.
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