|
|
Back to 2017 Program and Abstracts
A SINGLE INSTITUTION'S 27-YEAR SURGICAL EXPERIENCE WITH PANCREATIC NEUROENDOCRINE TUMORS: TIME TRENDS, COMPARISON OF CURRENT STAGING SYSTEMS AND OUTCOME ANALYSIS
Giovanni Marchegiani*, Tommaso Pollini, Salvatore Paiella, Marco Miotto, Anna Malpaga, Harmony Impellizzeri, Isacco Damoli, Beatrice Bianchi, Tommaso Baroni, Caterina Costanza Zingaretti, Chiara Nessi, Lorenzo Crepaz, Roberto Salvia, Luca Landoni
Surgery, Verona University Pancreas Institute, Verona, Italy
INTRODUCTION and AIM: Because of their rarity and heterogeneity, Pancreatic Neuroendocrine Tumors (Pan-Net) still represent a clinical dilemma. In particular, there is scarcity of data regarding their long term follow-up after surgical resection. Aim of the present analysis is to evaluate an almost three decade long activity at a high-volume pancreatic Institution. We sought to evaluate the time trends in surgical indications, to compare the current staging systems, and to find reliable predictors of postoperative outcome.
METHODS: The Institutional PanNET database was queried identifying 587 resected cases from 1988 to 2015. To evaluate the time trends of clinical management, the time span was arbitrarily divided in three clusters allowing for a balanced comparison between groups of patients. Current staging systems (AJCC and ENETS) were evaluated for recurrence prognostication validity as measured by discrimination (Harrel’s c-index, HCI). Univariate and multivariate analysis for predictors of both recurrence and survival were performed, together with a conditional survival analysis.
RESULTS: Of the 587 resected PanNETs, 75% were non-functioning, and 5% syndrome-associated. Mean age was 54 (± 14), and 51% of patients were female. The median tumor size was 20 mm (range 4-140), 62% were G1, 32% G2, and 4% were G3. Time trends analysis revealed that the number of resected PanNETs has constantly increased, while size (from 25 mm to 20 mm) and G1 proportion (from 65% to 49%) of resected tumors decreased during the study period. Comparison of current staging system revealed both AJCC and ENETS to be valid a comparable in terms of recurrence prognostication. After a mean follow-up of 75 moths, recurrence analysis revealed that non-functioning tumors, grading, N1 status and vascular invasion were all independent predictors of recurrence. Regardless of tumor size, G1 non-functioning tumors with no lymph node involvement and vascular invasion had a negligible risk of recurrence at 5 years.
CONCLUSIONS: PanNETs have been increasingly diagnosed ad resected during the last three decades at a high-volume Institutions, revealing reliable predictors of outcome. Both the AJCC and ENETS staging systems are valid prognostic tools in terms of risk of recurrence.
Back to 2017 Program and Abstracts
|
