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Erschienen in: World Journal of Surgery 1/2019

10.08.2018 | Original Scientific Report

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

verfasst von: Ioannis Mintziras, Tobias Keck, Jens Werner, Stefan Fichtner-Feigl, Uwe Wittel, Norbert Senninger, Thorsten Vowinkel, Jörg Köninger, Matthias Anthuber, Bernd Geißler, Detlef Klaus Bartsch, for the StuDoQ|Pancreas study group of the German Society for General and Visceral Surgery (DGAV)

Erschienen in: World Journal of Surgery | Ausgabe 1/2019

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Abstract

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.
Literatur
1.
Zurück zum Zitat Yao JC, Hassan M, Phan A et al (2008) One hundred years after « carcinoid » : epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 26:3063–3072CrossRefPubMed Yao JC, Hassan M, Phan A et al (2008) One hundred years after « carcinoid » : epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 26:3063–3072CrossRefPubMed
2.
Zurück zum Zitat Ito T, Lee L, Hijioka M et al (2015) The up-to-date review of epidemiological pancreatic neuroendocrine tumors in Japan. J Hepatobiliary Pancreat Sci 22:574–577CrossRefPubMed Ito T, Lee L, Hijioka M et al (2015) The up-to-date review of epidemiological pancreatic neuroendocrine tumors in Japan. J Hepatobiliary Pancreat Sci 22:574–577CrossRefPubMed
3.
Zurück zum Zitat Metz DC, Jensen RT (2008) Gastrointestinal neuroendocrine tumors: pancreatic endocrine tumors. Gastroenterology 135:1469–1492CrossRefPubMed Metz DC, Jensen RT (2008) Gastrointestinal neuroendocrine tumors: pancreatic endocrine tumors. Gastroenterology 135:1469–1492CrossRefPubMed
4.
Zurück zum Zitat Halfdanarson TR, Rabe KG, Rubin J et al (2008) Pancreatic neuroendocrine tumors (PNETs): incidence, prognosis, and recent trend toward improved survival. Ann Oncol 19:1727–1733CrossRefPubMedPubMedCentral Halfdanarson TR, Rabe KG, Rubin J et al (2008) Pancreatic neuroendocrine tumors (PNETs): incidence, prognosis, and recent trend toward improved survival. Ann Oncol 19:1727–1733CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat Kulke MH, Anthony LB, Bushnell DL et al (2010) NANETS treatment guidelines: well-differentiated neuroendocrine tumors of the stomach and pancreas. Pancreas 39:735–752CrossRefPubMedPubMedCentral Kulke MH, Anthony LB, Bushnell DL et al (2010) NANETS treatment guidelines: well-differentiated neuroendocrine tumors of the stomach and pancreas. Pancreas 39:735–752CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Falconi M, Bartsch DK, Eriksson B et al (2012) ENETS consensus guidelines for the management of patients with digestive neuroendocrine neoplasms of the digestive system: well-differentiated pancreatic non-functioning tumors. Neuroendocrinology 95(2):120–134CrossRefPubMed Falconi M, Bartsch DK, Eriksson B et al (2012) ENETS consensus guidelines for the management of patients with digestive neuroendocrine neoplasms of the digestive system: well-differentiated pancreatic non-functioning tumors. Neuroendocrinology 95(2):120–134CrossRefPubMed
7.
Zurück zum Zitat Falconi M, Eriksson B, Kaltsas G et al (2016) ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors. Neuroendocrinology 103(2):153–171CrossRefPubMed Falconi M, Eriksson B, Kaltsas G et al (2016) ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors. Neuroendocrinology 103(2):153–171CrossRefPubMed
8.
Zurück zum Zitat Partelli S, Bartsch DK, Capdevila J et al (2017) ENETS consensus guidelines for standard of care in neuroendocrine tumours: surgery for small intestinal and pancreatic neuroendocrine tumours. Neuroendocrinology 105(3):255–265CrossRefPubMed Partelli S, Bartsch DK, Capdevila J et al (2017) ENETS consensus guidelines for standard of care in neuroendocrine tumours: surgery for small intestinal and pancreatic neuroendocrine tumours. Neuroendocrinology 105(3):255–265CrossRefPubMed
9.
Zurück zum Zitat Wellner UF, Klinger C, Lehmann K et al (2017) The pancreatic surgery registry (StuDoQ|Pancreas) of the German society for general and visceral Surgery (DGAV)—presentation and systematic quality evaluation. Trials 18(1):163CrossRefPubMedPubMedCentral Wellner UF, Klinger C, Lehmann K et al (2017) The pancreatic surgery registry (StuDoQ|Pancreas) of the German society for general and visceral Surgery (DGAV)—presentation and systematic quality evaluation. Trials 18(1):163CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Krautz C, Nimptsch U, Weber GF et al (2018) Effect of hospital volume on in-hospital morbidity and mortality following pancreatic surgery in Germany. Ann Surg 267(3):411–417CrossRefPubMed Krautz C, Nimptsch U, Weber GF et al (2018) Effect of hospital volume on in-hospital morbidity and mortality following pancreatic surgery in Germany. Ann Surg 267(3):411–417CrossRefPubMed
11.
Zurück zum Zitat Klöppel G, Rindi G, Perren A et al (2010) The ENETS and AJCC/UICC TNM classifications of the neuroendocrine tumors of the gastrointestinal tract and the pancreas: a statement. Virchows Arch 456(6):595–597CrossRefPubMed Klöppel G, Rindi G, Perren A et al (2010) The ENETS and AJCC/UICC TNM classifications of the neuroendocrine tumors of the gastrointestinal tract and the pancreas: a statement. Virchows Arch 456(6):595–597CrossRefPubMed
12.
Zurück zum Zitat Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13CrossRefPubMed Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13CrossRefPubMed
13.
Zurück zum Zitat Wente MN, Veit JA, Bassi C et al (2007) Postpancreatectomy hemorrhage (PPH)—an international study group of pancreatic surgery (ISGPS) definition. Surgery 142:20–25CrossRefPubMed Wente MN, Veit JA, Bassi C et al (2007) Postpancreatectomy hemorrhage (PPH)—an international study group of pancreatic surgery (ISGPS) definition. Surgery 142:20–25CrossRefPubMed
14.
Zurück zum Zitat Wente MN, Bassi C, Dervenis C et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the international study group of pancreatic surgery (ISGPS). Surgery 142:761–768CrossRefPubMed Wente MN, Bassi C, Dervenis C et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the international study group of pancreatic surgery (ISGPS). Surgery 142:761–768CrossRefPubMed
15.
Zurück zum Zitat Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Plöckinger U, Rindi G, Arnold R et al (2004) Guidelines for the diagnosis and treatment of neuroendocrine gastrointestinal tumours. A consensus statement on behalf of the European neuroendocrine tumour Society (ENETS. Neuroendocrinology 80(6):394–424CrossRefPubMed Plöckinger U, Rindi G, Arnold R et al (2004) Guidelines for the diagnosis and treatment of neuroendocrine gastrointestinal tumours. A consensus statement on behalf of the European neuroendocrine tumour Society (ENETS. Neuroendocrinology 80(6):394–424CrossRefPubMed
17.
Zurück zum Zitat Lee LC, Grant CS, Salomao DR et al (2012) Small, nonfunctioning, asymptomatic pancreatic neuroendocrine tumors (PNETs): role for nonoperative management. Surgery 152:965–974CrossRefPubMed Lee LC, Grant CS, Salomao DR et al (2012) Small, nonfunctioning, asymptomatic pancreatic neuroendocrine tumors (PNETs): role for nonoperative management. Surgery 152:965–974CrossRefPubMed
18.
Zurück zum Zitat Gaujoux S, Partelli S, Maire F et al (2013) Observational study of natural history of small sporadic nonfunctioning pancreatic neuroendocrine tumors. J Clin Endocrinol Metab 98:4784–4789CrossRefPubMed Gaujoux S, Partelli S, Maire F et al (2013) Observational study of natural history of small sporadic nonfunctioning pancreatic neuroendocrine tumors. J Clin Endocrinol Metab 98:4784–4789CrossRefPubMed
19.
Zurück zum Zitat Partelli S, Cirocchi R, Crippa S et al (2017) Systematic review of active surveillance versus surgical management of asymptomatic small non-functioning pancreatic neuroendocrine neoplasms. Br J Surg 104(1):34–41CrossRefPubMed Partelli S, Cirocchi R, Crippa S et al (2017) Systematic review of active surveillance versus surgical management of asymptomatic small non-functioning pancreatic neuroendocrine neoplasms. Br J Surg 104(1):34–41CrossRefPubMed
20.
Zurück zum Zitat Sharpe SM, In H, Winchester DJ et al (2015) Surgical resection provides an overall survival benefit for patients with small pancreatic neuroendocrine tumors. J Gastrointest Surg 19(1):117–123CrossRefPubMed Sharpe SM, In H, Winchester DJ et al (2015) Surgical resection provides an overall survival benefit for patients with small pancreatic neuroendocrine tumors. J Gastrointest Surg 19(1):117–123CrossRefPubMed
21.
Zurück zum Zitat Haynes AB, Deshpande V, Ingkakul T et al (2011) Implications of incidentally discovered, non-functioning pancreatic endocrine tumors: short-term and long-term patient outcomes. Arch Surg 146:534–538CrossRefPubMedPubMedCentral Haynes AB, Deshpande V, Ingkakul T et al (2011) Implications of incidentally discovered, non-functioning pancreatic endocrine tumors: short-term and long-term patient outcomes. Arch Surg 146:534–538CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Jutric Z, Grendar J, Hoen HM et al (2017) Regional metastatic behavior of nonfunctional pancreatic neuroendocrine tumors: impact of lymph node positivity on survival. Pancreas 46(7):898–903CrossRefPubMed Jutric Z, Grendar J, Hoen HM et al (2017) Regional metastatic behavior of nonfunctional pancreatic neuroendocrine tumors: impact of lymph node positivity on survival. Pancreas 46(7):898–903CrossRefPubMed
23.
Zurück zum Zitat Manta R, Nardi E, Pagano N et al (2016) Pre-operative diagnosis of pancreatic neuroendocrine tumors with endoscopic ultrasonography and computed tomography in a large series. J Gastrointestin Liver Dis 25(3):317–321PubMed Manta R, Nardi E, Pagano N et al (2016) Pre-operative diagnosis of pancreatic neuroendocrine tumors with endoscopic ultrasonography and computed tomography in a large series. J Gastrointestin Liver Dis 25(3):317–321PubMed
24.
Zurück zum Zitat Boutsen L, Jouret-Mourin A, Borbath I et al (2018) Accuracy of pancreatic neuroendocrine tumour grading by endoscopic ultrasound-guided fine needle aspiration: analysis of a large cohort and perspectives for improvement. Neuroendocrinology 106(2):158–166CrossRefPubMed Boutsen L, Jouret-Mourin A, Borbath I et al (2018) Accuracy of pancreatic neuroendocrine tumour grading by endoscopic ultrasound-guided fine needle aspiration: analysis of a large cohort and perspectives for improvement. Neuroendocrinology 106(2):158–166CrossRefPubMed
26.
Zurück zum Zitat Sallinen VJ, Le Large TTY, Tieftrunk E et al (2017) Prognosis of sporadic resected small (≤2 cm) nonfunctional pancreatic neuroendocrine tumors—a multi-institutional study. HPB (Oxford) 20:251–259CrossRef Sallinen VJ, Le Large TTY, Tieftrunk E et al (2017) Prognosis of sporadic resected small (≤2 cm) nonfunctional pancreatic neuroendocrine tumors—a multi-institutional study. HPB (Oxford) 20:251–259CrossRef
27.
Zurück zum Zitat Chua TC, Yang TX, Gill AJ et al (2016) Systematic review and meta-analysis of enucleation versus standardized resection for small pancreatic lesions. Ann Surg Oncol 23(2):592–599CrossRefPubMed Chua TC, Yang TX, Gill AJ et al (2016) Systematic review and meta-analysis of enucleation versus standardized resection for small pancreatic lesions. Ann Surg Oncol 23(2):592–599CrossRefPubMed
28.
Zurück zum Zitat Nimptsch U, Krautz C, Weber GF et al (2016) Nationwide in-hospital mortality following pancreatic surgery in Germany is higher than anticipated. Ann Surg 264(6):1082–1090CrossRefPubMed Nimptsch U, Krautz C, Weber GF et al (2016) Nationwide in-hospital mortality following pancreatic surgery in Germany is higher than anticipated. Ann Surg 264(6):1082–1090CrossRefPubMed
29.
Zurück zum Zitat Siech M, Bartsch D, Beger HG et al (2012) Indications for laparoscopic pancreas operations: results of a consensus conference and the previous laparoscopic pancreas register. Chirurg 83(3):247–253CrossRefPubMed Siech M, Bartsch D, Beger HG et al (2012) Indications for laparoscopic pancreas operations: results of a consensus conference and the previous laparoscopic pancreas register. Chirurg 83(3):247–253CrossRefPubMed
30.
Zurück zum Zitat Drymousis P, Raptis DA, Spalding D et al (2014) Laparoscopic versus open pancreas resection for pancreatic neuroendocrine tumours: a systematic review and meta-analysis. HPB (Oxford) 16(5):397–406CrossRef Drymousis P, Raptis DA, Spalding D et al (2014) Laparoscopic versus open pancreas resection for pancreatic neuroendocrine tumours: a systematic review and meta-analysis. HPB (Oxford) 16(5):397–406CrossRef
31.
Zurück zum Zitat Scherübl H, Streller B, Stabenow R et al (2013) Clinically detected gastroenteropancreatic neuroendocrine tumors are on the rise: epidemiological changes in Germany. World J Gastroenterol 19(47):9012–9019CrossRefPubMedPubMedCentral Scherübl H, Streller B, Stabenow R et al (2013) Clinically detected gastroenteropancreatic neuroendocrine tumors are on the rise: epidemiological changes in Germany. World J Gastroenterol 19(47):9012–9019CrossRefPubMedPubMedCentral
32.
Zurück zum Zitat Begum N, Maasberg S, Plöckinger U et al (2014) Neuroendocrine tumours of the GI tract—data from the German NET registry. Zentralbl Chir 139(3):276–283PubMed Begum N, Maasberg S, Plöckinger U et al (2014) Neuroendocrine tumours of the GI tract—data from the German NET registry. Zentralbl Chir 139(3):276–283PubMed
33.
Zurück zum Zitat Kuo EJ, Salem RR (2013) Population-level analysis of pancreatic neuroendocrine tumors 2 cm or less in size. Ann Surg Oncol 20(9):2815–2821CrossRefPubMed Kuo EJ, Salem RR (2013) Population-level analysis of pancreatic neuroendocrine tumors 2 cm or less in size. Ann Surg Oncol 20(9):2815–2821CrossRefPubMed
Metadaten
Titel
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
verfasst von
Ioannis Mintziras
Tobias Keck
Jens Werner
Stefan Fichtner-Feigl
Uwe Wittel
Norbert Senninger
Thorsten Vowinkel
Jörg Köninger
Matthias Anthuber
Bernd Geißler
Detlef Klaus Bartsch
for the StuDoQ|Pancreas study group of the German Society for General and Visceral Surgery (DGAV)
Publikationsdatum
10.08.2018
Verlag
Springer International Publishing
Erschienen in
World Journal of Surgery / Ausgabe 1/2019
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-018-4751-2

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