Implementation of Current ENETS Guidelines for Surgery of Small (≤2 cm) Pancreatic Neuroendocrine Neoplasms in the German Surgical Community: An Analysis of the Prospective DGAV StuDoQ|Pancreas Registry.
Female
Germany
Guideline Adherence
Humans
Laparoscopy
/ statistics & numerical data
Length of Stay
/ statistics & numerical data
Lymph Node Excision
/ statistics & numerical data
Lymphatic Metastasis
Male
Middle Aged
Neuroendocrine Tumors
/ pathology
Operative Time
Pancreatectomy
/ statistics & numerical data
Pancreatic Neoplasms
/ pathology
Pancreaticoduodenectomy
/ statistics & numerical data
Postoperative Complications
Practice Guidelines as Topic
Registries
Journal
World journal of surgery
ISSN: 1432-2323
Titre abrégé: World J Surg
Pays: United States
ID NLM: 7704052
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
pubmed:
12
8
2018
medline:
23
2
2019
entrez:
12
8
2018
Statut:
ppublish
Résumé
ENETS guidelines recommend parenchyma-sparing procedures without formal lymphadenectomy, ideally with a minimally invasive laparoscopic approach for sporadic small pNENs (≤2 cm). Non-functioning (NF) small pNENs can also be observed. The aim of the study was to evaluate how these recommendations are implemented in the German surgical community. Data from the prospective StuDoQ|Pancreas registry of the German Society of General and Visceral Surgery were analyzed regarding patient's demographics, tumor characteristics, surgical procedures, histology and perioperative outcomes. Eighty-four (29.2%) of 287 patients had sporadic pNENs ≤2 cm. Forty-three (51.2%) patients were male, and the mean age at diagnosis was 58.8 ± 15.6 years. Twenty-five (29.8%) pNENs were located in the pancreatic head. The diagnosis pNEN was preoperatively established in 53 (65%) of 84 patients. Sixty-two (73.8%) patients had formal pancreatic resections, including partial pancreaticoduodenectomy or total pancreatectomy (21.4%). Only 22 (26.2%) patients underwent parenchyma-sparing resections and 23 (27.4%) patients had minimally invasive procedures. A lymphadenectomy was performed in 63 (75.4%) patients, and lymph node metastases were diagnosed in 6 (7.2%) patients. Eighty-two (97.7%) patients had an R0 resection. Sixty (72%) tumors were classified G1, 24 (28%) tumors G2. Twenty-seven (32.2%) of 84 patients had postoperative relevant Clavien-Dindo grade ≥3 complications. Thirty- and 90-day mortalities were 2.4% and 3.6%. ENETS guidelines for surgery of small pNENs are yet not well accepted in the German surgical community, since the rate of formal resections with standard lymphadenectomy is high and the minimally invasive approach is underused. The attitude to operate small NF tumors seems to be rather aggressive.
Sections du résumé
BACKGROUND
ENETS guidelines recommend parenchyma-sparing procedures without formal lymphadenectomy, ideally with a minimally invasive laparoscopic approach for sporadic small pNENs (≤2 cm). Non-functioning (NF) small pNENs can also be observed. The aim of the study was to evaluate how these recommendations are implemented in the German surgical community.
METHODS
Data from the prospective StuDoQ|Pancreas registry of the German Society of General and Visceral Surgery were analyzed regarding patient's demographics, tumor characteristics, surgical procedures, histology and perioperative outcomes.
RESULTS
Eighty-four (29.2%) of 287 patients had sporadic pNENs ≤2 cm. Forty-three (51.2%) patients were male, and the mean age at diagnosis was 58.8 ± 15.6 years. Twenty-five (29.8%) pNENs were located in the pancreatic head. The diagnosis pNEN was preoperatively established in 53 (65%) of 84 patients. Sixty-two (73.8%) patients had formal pancreatic resections, including partial pancreaticoduodenectomy or total pancreatectomy (21.4%). Only 22 (26.2%) patients underwent parenchyma-sparing resections and 23 (27.4%) patients had minimally invasive procedures. A lymphadenectomy was performed in 63 (75.4%) patients, and lymph node metastases were diagnosed in 6 (7.2%) patients. Eighty-two (97.7%) patients had an R0 resection. Sixty (72%) tumors were classified G1, 24 (28%) tumors G2. Twenty-seven (32.2%) of 84 patients had postoperative relevant Clavien-Dindo grade ≥3 complications. Thirty- and 90-day mortalities were 2.4% and 3.6%.
CONCLUSIONS
ENETS guidelines for surgery of small pNENs are yet not well accepted in the German surgical community, since the rate of formal resections with standard lymphadenectomy is high and the minimally invasive approach is underused. The attitude to operate small NF tumors seems to be rather aggressive.
Identifiants
pubmed: 30097704
doi: 10.1007/s00268-018-4751-2
pii: 10.1007/s00268-018-4751-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
175-182Investigateurs
Michael Ghadimi
(M)
Stefan Post
(S)
Torsten J Wilhelm
(TJ)
Christoph-Thomas Germer
(CT)
Waldemar Uhl
(W)
Orlin Belyaev
(O)
Thomas Kraus
(T)
Helmut Witzigmann
(H)
Merten Hommann
(M)
Ernst Klar
(E)
Matthias Glanemann
(M)
Carsten Gutt
(C)
Thomas Manger
(T)
Hans-Jörg Krämling
(HJ)
Jörg C Kalff
(JC)
Tim R Glowka
(TR)
Natascha C Nüssler
(NC)
Jörg-Peter Ritz
(JP)
Winfried Padberg
(W)
Anton J Kroesen
(AJ)
Albrecht Stier
(A)
Dietmar Lorenz
(D)
Wolf Otto Bechstein
(WO)
Karl-Jürgen Oldhafer
(KJ)
Sven Eisold
(S)
Ute Tröbs
(U)
Hans-Bernd Reith
(HB)
Franz-Josef Schumacher
(FJ)
Elke Wagler
(E)
Stefan Farkas
(S)
Frank Klammer
(F)
Matthias Schwarzbach
(M)
Marco Niedergethmann
(M)
Norbert Runkel
(N)
Pompiliu Piso
(P)
Eric P M Lorenz
(EPM)
Christian Mönch
(C)
Steffanie Bieck
(S)
Robert Grützmann
(R)
Max Brunner
(M)
Helmut Friess
(H)
Références
Ann Surg. 2004 Aug;240(2):205-13
pubmed: 15273542
Neuroendocrinology. 2004;80(6):394-424
pubmed: 15838182
Surgery. 2005 Jul;138(1):8-13
pubmed: 16003309
Surgery. 2007 Jul;142(1):20-5
pubmed: 17629996
Surgery. 2007 Nov;142(5):761-8
pubmed: 17981197
Ann Oncol. 2008 Oct;19(10):1727-33
pubmed: 18515795
J Clin Oncol. 2008 Jun 20;26(18):3063-72
pubmed: 18565894
Gastroenterology. 2008 Nov;135(5):1469-92
pubmed: 18703061
Virchows Arch. 2010 Jun;456(6):595-7
pubmed: 20422210
Pancreas. 2010 Aug;39(6):735-52
pubmed: 20664472
Arch Surg. 2011 May;146(5):534-8
pubmed: 21576607
Chirurg. 2012 Mar;83(3):247-53
pubmed: 21901465
Neuroendocrinology. 2012;95(2):120-34
pubmed: 22261872
Zentralbl Chir. 2014 Jun;139(3):276-83
pubmed: 23042103
Surgery. 2012 Dec;152(6):965-74
pubmed: 23102679
Ann Surg Oncol. 2013 Sep;20(9):2815-21
pubmed: 23771245
J Clin Endocrinol Metab. 2013 Dec;98(12):4784-9
pubmed: 24057286
HPB (Oxford). 2014 May;16(5):397-406
pubmed: 24245906
World J Gastroenterol. 2013 Dec 21;19(47):9012-9
pubmed: 24379626
J Gastrointest Surg. 2015 Jan;19(1):117-23; discussion 123
pubmed: 25155459
J Hepatobiliary Pancreat Sci. 2015 Aug;22(8):574-7
pubmed: 25689058
Ann Surg Oncol. 2016 Feb;23(2):592-9
pubmed: 26307231
Neuroendocrinology. 2016;103(2):153-71
pubmed: 26742109
Ann Surg. 2016 Dec;264(6):1082-1090
pubmed: 26978570
J Gastrointestin Liver Dis. 2016 Sep;25(3):317-21
pubmed: 27689195
Br J Surg. 2017 Jan;104(1):34-41
pubmed: 27706803
Neuroendocrinology. 2017 Feb 25;105(3):255-265
pubmed: 28237989
Ann Surg. 2018 Mar;267(3):411-417
pubmed: 28379871
Trials. 2017 Apr 5;18(1):163
pubmed: 28381291
Neuroendocrinology. 2018;106(2):158-166
pubmed: 28494461
Pancreas. 2017 Aug;46(7):898-903
pubmed: 28697130
HPB (Oxford). 2018 Mar;20(3):251-259
pubmed: 28988702
World J Surg. 2018 May;42(5):1440-1447
pubmed: 29075857