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Palliative resection of the primary tumor in 442 metastasized neuroendocrine tumors of the pancreas: a population-based, propensity score-matched survival analysis

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Abstract

Purpose

There is an ongoing debate on whether palliative removal of the primary tumor may result in a survival benefit for patients with incurable stage IV pancreatic neuroendocrine tumors (P-NET). The objective of this study was to assess whether palliative resection of the primary tumor in patients with incurable stage IV P-NET has an impact on survival.

Methods

Patients with stage IV P-NET registered in the Surveillance, Epidemiology, and End Results database between 2004 and 2011 were identified. Those undergoing resection of metastases were excluded. Overall and cancer-specific survival of patients who did and did not undergo resection of their primary tumor were compared by means of risk-adjusted Cox proportional hazard regression analysis and propensity score-matched analysis.

Results

A total of 442 stage IV P-NET patients were identified, of whom 75 (17.0 %) underwent palliative primary tumor resection. The latter showed a significant benefit in both overall survival (hazard ratio [HR] of death = 0.41, 95 % confidence interval [CI] 0.25–0.66, p < 0.001) and cancer-specific survival (HR of death = 0.41, 95 % CI 0.25–0.67, p < 0.001) in unadjusted multivariate Cox regression analysis; the benefit persisted after propensity score adjustment.

Conclusions

This population-based analysis of stage IV P-NET patients provides compelling evidence that palliative resection of the primary tumor is associated with significant survival benefit. Thus, the recent recommendations judging resection of the primary as inadvisable and the accompanying trend towards fewer palliative resections of the primary tumor have to be contested.

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Acknowledgments

The authors thank the National Cancer Institute for providing the SEER registry data.

Funding

No funding was received for this study.

Conflicts of interest

The authors declare that no conflicts of interest exist in relation to this study.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Since the data source for this retrospective study was the SEER database of the National Cancer Institute of the United States of America, no formal consent is required for this type of study.

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    Authors and Affiliations

    1. Department of General, Visceral, and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany

      Felix J. Hüttner, Lutz Schneider, Ignazio Tarantino, Thilo Hackert, Markus K. Diener, Markus W. Büchler & Alexis Ulrich

    2. Study Center of the German Surgical Society, University of Heidelberg, Heidelberg, Germany

      Felix J. Hüttner & Markus K. Diener

    3. Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland

      Rene Warschkow & Bruno M. Schmied

    4. Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, Heidelberg, 69120, Germany

      Rene Warschkow

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    1. Felix J. Hüttner
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    Correspondence to Alexis Ulrich.

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    Authors’ contributions

    Study conception and design: F. J. Hüttner, L. Schneider, I. Tarantino, R. Warschkow, M. K. Diener. Acquisition of data: F. J. Hüttner, L. Schneider, I. Tarantino, R. Warschkow. Analysis and interpretation of data: F. J. Hüttner, L. Schneider, R. Warschkow, B. M. Schmied, T. Hackert, M. W. Büchler, A. Ulrich. Drafting of manuscript: F. J. Hüttner, L. Schneider, I. Tarantino, R. Warschkow, M. K. Diener. Critical revision of manuscript: B. M. Schmied, T. Hackert, M. W. Büchler, A. Ulrich. All authors read and approved the final manuscript.

    Felix J. Hüttner and Lutz Schneider contributed equally to this work.

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    Hüttner, F.J., Schneider, L., Tarantino, I. et al. Palliative resection of the primary tumor in 442 metastasized neuroendocrine tumors of the pancreas: a population-based, propensity score-matched survival analysis. Langenbecks Arch Surg 400, 715–723 (2015). https://doi.org/10.1007/s00423-015-1323-x

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    • DOI: https://doi.org/10.1007/s00423-015-1323-x

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