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10.08.2018 | Original Scientific Report | Ausgabe 1/2019

World Journal of Surgery 1/2019

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

Zeitschrift:
World Journal of Surgery > Ausgabe 1/2019
Autoren:
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)

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.

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