In localized, asymptomatic pancreatic neuroendocrine tumors, surgical benefit looks doubtful

  • Powers BD & al.
  • J Gastrointest Surg
  • 21 Nov 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • An analysis of the Surveillance, Epidemiology, and End Results (SEER) database shows no cancer-specific survival (CSS) benefit of surgery for localized, asymptomatic pancreatic neuroendocrine tumors (PNETs).

Why this matters

  • Previous analyses have shown a benefit of surgery with OS, but those results may have been skewed by a tendency to perform surgery on healthier patients.
  • The study is also the first to look at the effect of surgery on asymptomatic PNETs since the implementation of a new staging system in the eighth edition of the AJCC Staging Manual.

Study design

  • Retrospective analysis of data from the SEER database (n=709).
  • Funding: None disclosed.

Key results

  • 88.6% of patients with stage I PNET underwent surgery.
  • Median follow-up, 24 months.
  • CSS was 98.2% with surgery and 98.6% without surgery.
  • 4.1% of patients in the surgery group died compared with 13.6% in the nonsurgery group (aHR, 0.32; 95% CI, 0.15-0.70).
  • Cancer-specific death rate was 1.4% in the surgery group and 2.5% in the nonsurgery group, but the difference was not statistically significant (aHR, 0.42; 95% CI, 0.09-1.99).

Limitations

  • Retrospective analysis.