Assessing the role of primary tumour resection in patients with synchronous unresectable liver metastases from pancreatic neuroendocrine tumour of the body and tail. A propensity score survival evaluation

Abstract Background The role of primary tumour surgery in pancreatic neuroendocrine tumours (PNETs) with unresectable liver metastases is controversial and international guidelines do not recommend surgery in such cases. Resectability of the primary tumour has never been considered in outcome compar...

Full description

Saved in:
Bibliographic Details
Published in:European journal of surgical oncology 2017-02, Vol.43 (2), p.372-379
Main Authors: Bertani, E, Fazio, N, Radice, D, Zardini, C, Spinoglio, G, Chiappa, A, Ribero, D, Biffi, R, Partelli, S, Falconi, M
Format: Article
Language:English
Subjects:
Female
Hematology, Oncology and Palliative Medicine
Humans
Italy
Liver Neoplasms - secondary
Liver Neoplasms - surgery
Male
Middle Aged
Neoplasms, Multiple Primary - surgery
Neuroendocrine Tumors - secondary
Neuroendocrine Tumors - surgery
Pancreatectomy
Pancreatic Neoplasms - pathology
Pancreatic Neoplasms - surgery
Pancreatic neuroendocrine tumours
Prognostic factors
Propensity Score
Prospective Studies
Registries
Resection
Surgery
Survival
Survival Rate
Synchronous liver metastases
Treatment Outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract Background The role of primary tumour surgery in pancreatic neuroendocrine tumours (PNETs) with unresectable liver metastases is controversial and international guidelines do not recommend surgery in such cases. Resectability of the primary tumour has never been considered in outcome comparisons between operated and non-operated patients. Methods From two institutional prospective databases of patients affected by PNET and unresectable liver metastases, 63 patients who underwent a left-pancreatectomy at diagnosis were identified and compared with a group of 30 patients with a potentially resectable but not-resected primary tumour located in the body or tail. The endpoint was overall survival (OS). Results The two groups significantly differed at baseline with regard to liver tumour burden Ki-67 labelling index, site of pancreas, results of the18 FDG PET-CT and age. In the operated patients, surgical morbidity comprised 7 cases of pancreatic fistula. Postoperative mortality was nil. Median OS for patients undergoing left-pancreatectomy was 111 months vs 52 for the non operated patients (p = 0.003). At multivariate analysis after propensity score adjustment, no surgery as well as liver tumour burden>25% and higher Ki-67 index were associated with an increased risk of death during follow-up. In patients with unresectable primary tumour, OS was similar in comparison to that in the resectable but non-resected patients, and significantly worse than that in the resected patients (p = 0.032). Conclusion In PNETs located in the body or tail and diffuse liver metastases distal pancreatectomy may be justified in selected patients. Randomized studies may be safely proposed in future on this topic.
ISSN:0748-7983
1532-2157
DOI:10.1016/j.ejso.2016.09.011