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Erschienen in: Journal of Gastrointestinal Surgery 5/2017

02.03.2017 | Original Article

Pancreatic Neuroendocrine Tumors (panNETs): Analysis of Overall Survival of Nonsurgical Management Versus Surgical Resection

verfasst von: Paige Finkelstein, Rishika Sharma, Omar Picado, Rahul Gadde, Heather Stuart, Caroline Ripat, Alan S. Livingstone, Danny Sleeman, Nipun Merchant, Danny Yakoub

Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 5/2017

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Abstract

Background

Outcomes of patients with pancreatic neuroendocrine tumors (panNETs) undergoing surgical or nonsurgical management and outcomes of enucleation versus standard resection were compared.

Methods

MEDLINE, EMBASE, PubMed, Scopus, and Cochrane were queried (2000 to present). All studies comparing patients undergoing surgical versus nonsurgical treatments, or enucleation versus standard resection, were included. Pooled risk ratios and 95% CI for survival were calculated.

Results

Eleven studies met criteria with 1491 resected and 1607 nonsurgically managed patients. Meta-analysis showed improved overall survival with resection at 1 year (risk ratio (RR) = 1.281, CI 1.064–1.542, p = 0.009), 3 years (RR = 1.837, CI 1.594–2.117, p < 0.001), and 5 years (RR = 2.103, CI 1.50–2.945, p < 0.001). OS of patients with resected nonfunctioning panNETs was improved at 3 years (RR = 1.847, CI 1.477–2.309, p < 0.001) and 5 years (RR = 1.767, CI 1.068–2.924, p = 0.027). OS was improved when panNETs ≤2 cm were resected at 3 years (RR = 1.695, CI 1.269–2.264, p < 0.001) and 5 years (RR = 2.210, CI 1.749–2.791, p < 0.001). Fifteen articles met criteria for enucleation versus standard resection (n = 1035; 620 were nonfunctioning). Enucleation had shorter operative time (weighted mean difference (WMD) = −95.6 min, 95% CI −131.4 to −59.8, p < 0.01), less operative blood loss (WMD = −172.6 ml, 95% CI −340 to −5.1, p = 0.04), but increased postoperative pancreatic fistula (POPF) (RR = 2.08, 95% CI 1.39–3.12, p < 0.01).

Conclusion

Surgical resection of panNETs, including small and nonfunctioning, appears to be associated with improved OS. Enucleation is associated with shorter operative time, less blood loss, but greater incidence of POPF. Prospective, randomized clinical trials are needed to confirm these results.
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Metadaten
Titel
Pancreatic Neuroendocrine Tumors (panNETs): Analysis of Overall Survival of Nonsurgical Management Versus Surgical Resection
verfasst von
Paige Finkelstein
Rishika Sharma
Omar Picado
Rahul Gadde
Heather Stuart
Caroline Ripat
Alan S. Livingstone
Danny Sleeman
Nipun Merchant
Danny Yakoub
Publikationsdatum
02.03.2017
Verlag
Springer US
Erschienen in
Journal of Gastrointestinal Surgery / Ausgabe 5/2017
Print ISSN: 1091-255X
Elektronische ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-017-3365-6

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