Endoscopic Ultrasound-guided Radiofrequency Ablation Versus Surgical Resection for Treatment of Pancreatic Insulinoma.

Humans Insulinoma / diagnostic imaging Pancreatic Neoplasms / diagnostic imaging Retrospective Studies Radiofrequency Ablation Treatment Outcome Ultrasonography, Interventional Catheter Ablation
Acute pancreatitis Hypoglycemia Insulin Neuroendocrine Tumor Pancreatic Fistula

Journal

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
ISSN: 1542-7714
Titre abrégé: Clin Gastroenterol Hepatol
Pays: United States
ID NLM: 101160775

Informations de publication

Date de publication:
10 2023
Historique:
received: 13 12 2022
revised: 14 02 2023
accepted: 21 02 2023
medline: 25 9 2023
pubmed: 6 3 2023
entrez: 5 3 2023
Statut: ppublish

Résumé

Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is emerging as a safe and effective treatment for pancreatic neuroendocrine tumors. We aimed to compare EUS-RFA and surgical resection for the treatment of pancreatic insulinoma (PI). Patients with sporadic PI who underwent EUS-RFA at 23 centers or surgical resection at 8 high-volume pancreatic surgery institutions between 2014 and 2022 were retrospectively identified and outcomes compared using a propensity-matching analysis. Primary outcome was safety. Secondary outcomes were clinical efficacy, hospital stay, and recurrence rate after EUS-RFA. Using propensity score matching, 89 patients were allocated in each group (1:1), and were evenly distributed in terms of age, sex, Charlson comorbidity index, American Society of Anesthesiologists score, body mass index, distance between lesion and main pancreatic duct, lesion site, size, and grade. Adverse event (AE) rate was 18.0% and 61.8% after EUS-RFA and surgery, respectively (P < .001). No severe AEs were observed in the EUS-RFA group compared with 15.7% after surgery (P < .0001). Clinical efficacy was 100% after surgery and 95.5% after EUS-RFA (P = .160). However, the mean duration of follow-up time was shorter in the EUS-RFA group (median, 23 months; interquartile range, 14-31 months vs 37 months; interquartile range, 17.5-67 months in the surgical group; P < .0001). Hospital stay was significantly longer in the surgical group (11.1 ± 9.7 vs 3.0 ± 2.5 days in the EUS-RFA group; P < .0001). Fifteen lesions (16.9%) recurred after EUS-RFA and underwent a successful repeat EUS-RFA (11 patients) or surgical resection (4 patients). EUS-RFA is safer than surgery and highly effective for the treatment of PI. If confirmed in a randomized study, EUS-RFA treatment can become first-line therapy for sporadic PI.

Sections du résumé

BACKGROUND & AIMS
Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is emerging as a safe and effective treatment for pancreatic neuroendocrine tumors. We aimed to compare EUS-RFA and surgical resection for the treatment of pancreatic insulinoma (PI).
METHODS
Patients with sporadic PI who underwent EUS-RFA at 23 centers or surgical resection at 8 high-volume pancreatic surgery institutions between 2014 and 2022 were retrospectively identified and outcomes compared using a propensity-matching analysis. Primary outcome was safety. Secondary outcomes were clinical efficacy, hospital stay, and recurrence rate after EUS-RFA.
RESULTS
Using propensity score matching, 89 patients were allocated in each group (1:1), and were evenly distributed in terms of age, sex, Charlson comorbidity index, American Society of Anesthesiologists score, body mass index, distance between lesion and main pancreatic duct, lesion site, size, and grade. Adverse event (AE) rate was 18.0% and 61.8% after EUS-RFA and surgery, respectively (P < .001). No severe AEs were observed in the EUS-RFA group compared with 15.7% after surgery (P < .0001). Clinical efficacy was 100% after surgery and 95.5% after EUS-RFA (P = .160). However, the mean duration of follow-up time was shorter in the EUS-RFA group (median, 23 months; interquartile range, 14-31 months vs 37 months; interquartile range, 17.5-67 months in the surgical group; P < .0001). Hospital stay was significantly longer in the surgical group (11.1 ± 9.7 vs 3.0 ± 2.5 days in the EUS-RFA group; P < .0001). Fifteen lesions (16.9%) recurred after EUS-RFA and underwent a successful repeat EUS-RFA (11 patients) or surgical resection (4 patients).
CONCLUSION
EUS-RFA is safer than surgery and highly effective for the treatment of PI. If confirmed in a randomized study, EUS-RFA treatment can become first-line therapy for sporadic PI.

Identifiants

DOI: 10.1016/j.cgh.2023.02.022 PMID: 36871765
pubmed: 36871765
pii: S1542-3565(23)00165-9
doi: 10.1016/j.cgh.2023.02.022
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

2834-2843.e2

Investigateurs

Sergio Alfieri (S)
Paolo Giorgio Arcidiacono (PG)
Marianna Arvanitakis (M)
Anna Battistella (A)
Laura Bernadroni (L)
Lene Brink (L)
Marcello Cintolo (M)
Maria Cristina Conti Bellocchi (MC)
Maria Vittoria Davì (MV)
Sophie Deguelte (S)
Pierre Deprez (P)
Jaques Deviere (J)
Jacques Ewald (J)
Carlo Fabbri (C)
Giovanni Ferrari (G)
Raluca Maria Furnica (RM)
Armando Gabbrielli (A)
Rodrigo Garcés-Duran (R)
Marc Giovannini (M)
Tamas Gonda (T)
Joan B Gornals (JB)
Mariola Marx (M)
Michele Mazzola (M)
Massimiliano Mutignani (M)
Andrew Ofosu (A)
Stephan P Pereira (SP)
Marine Perrier (M)
Adam Przybylkowski (A)
Alessandro Repici (A)
Sridhar Sundaram (S)
Giulia Tripodi (G)

Informations de copyright

Copyright © 2023 AGA Institute. Published by Elsevier Inc. All rights reserved.

Auteurs

Stefano Francesco Crinò (SF)

Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy. Electronic address: stefanofrancesco.crino@aovr.veneto.it.

Bertrand Napoleon (B)

Service de Gastroentérologie, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France.

Antonio Facciorusso (A)

Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.

Sundeep Lakhtakia (S)

Asian Institute of Gastroenterology, Hyderabad, India.

Ivan Borbath (I)

Department of Hepato-gastroenterology, Cliniques Universitaires St Luc, Brussels, Belgium.

Fabrice Caillol (F)

Endoscopy Unit, Paoli Calmettes Institute, Marseille, France.

Khanh Do-Cong Pham (K)

Department of Medicine, Haukeland University Hospital, Bergen, Norway.

Gianenrico Rizzatti (G)

Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

Edoardo Forti (E)

Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan, Italy.

Laurent Palazzo (L)

Department of Endoscopy, Trocadero Clinic, Paris, France.

Arthur Belle (A)

Department of Gastroenterology, Cochin Hospital, Paris, France.

Peter Vilmann (P)

Department of Gastroenterology, Herlev-Gentofte Hospital, Herlev, Denmark.

Jean-Luc van Laethem (JL)

Hepato-Gastroenterology, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.

Mehdi Mohamadnejad (M)

Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Sebastien Godat (S)

Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

Pieter Hindryckx (P)

Department of Gastroenterology, University of Ghent, Ghent, Belgium.

Ariel Benson (A)

Institute of Gastroenterology and Hepatology, Hadassah Medical Center, Jerusalem, Israel and Faculty of Medicine, Hebrew University of Jerusalem, Israel.

Matteo Tacelli (M)

Pancreato-biliary Endoscopy and EUS Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.

Germana De Nucci (G)

Gastroenterology and Endoscopy Unit, ASST Rhodense, Garbagnate Milanese, Milan, Italy.

Cecilia Binda (C)

Gastroenterology and Digestive Endoscopy Unit, Ospedale Morgagni-Pierantoni, AUSL Romagna, Forlì, Italy.

Bojan Kovacevic (B)

Department of Gastroenterology, Herlev-Gentofte Hospital, Herlev, Denmark.

Harold Jacob (H)

Institute of Gastroenterology and Hepatology, Hadassah Medical Center, Jerusalem, Israel and Faculty of Medicine, Hebrew University of Jerusalem, Israel.

Stefano Partelli (S)

Pancreatic and Transplant Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele IRCCS, Università Vita-Salute, Milan, Italy.

Massimo Falconi (M)

Pancreatic and Transplant Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele IRCCS, Università Vita-Salute, Milan, Italy.

Roberto Salvia (R)

General and Pancreatic Surgery Department, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.

Luca Landoni (L)

General and Pancreatic Surgery Department, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.

Alberto Larghi (A)

Department of Medicine, Haukeland University Hospital, Bergen, Norway.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Endoscopic Ultrasound-guided Radiofrequency...
questionsmedicales.fr › Maladies endocriniennes › Tumeurs des glandes endocrines › Tumeurs du pancréas › Adénome langerhansien › Insulinome › Endoscopic Ultrasound-guided Radiofrequency...
questionsmedicales.fr › Maladies endocriniennes › Tumeurs des glandes endocrines › Tumeurs du pancréas › Endoscopic Ultrasound-guided Radiofrequency...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Endoscopic Ultrasound-guided Radiofrequency...
questionsmedicales.fr › Procédures de chirurgie opératoire › Techniques d'ablation › Ablation par radiofréquence › Endoscopic Ultrasound-guided Radiofrequency...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Endoscopic Ultrasound-guided Radiofrequency...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Échographie interventionnelle › Endoscopic Ultrasound-guided Radiofrequency...
questionsmedicales.fr › Procédures de chirurgie opératoire › Techniques d'ablation › Ablation par radiofréquence › Ablation par cathéter › Endoscopic Ultrasound-guided Radiofrequency...