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J Surg Oncol. 2019 Jan;119(1):5-11. doi: 10.1002/jso.25306. Epub 2018 Nov 27.

The impact of failure to achieve symptom control after resection of functional neuroendocrine tumors: An 8-institution study from the US Neuroendocrine Tumor Study Group.

Author information

1
Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
2
Department of Surgery, Stanford University Medical Center, Stanford, California.
3
Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
4
Department of Surgery, Virginia Mason Medical Center, Seattle, Washington.
5
Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
6
Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
7
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
8
Department of Surgery, Washington University School of Medicine, St Louis, Missouri.

Abstract

BACKGROUND:

The goals of resection of functional neuroendocrine tumors (NETs) are two-fold: Oncological benefit and symptom control. The interaction between the two is not well understood.

METHODS:

All patients with functional NETs of the pancreas, duodenum, and ampulla who underwent curative-intent resection between 2000 and 2016 were identified. Using Cox regression analysis, factors associated with reduced recurrence-free survival (RFS) were identified.

RESULTS:

Two-hundred and thirty patients underwent curative-intent resection. Fifty-three percent were insulinomas, 35% gastrinomas, and 12% were other types. Twenty-one percent had a known genetic syndrome, 23% had lymph node (LN) positivity, 80% underwent an R0 resection, and 14% had no postoperative symptom improvement (SI). Factors associated with reduced RFS included noninsulinoma histology, the presence of a known genetic syndrome, LN positivity, R1 margin, and lack of SI. On multivariable analysis, only the failure to achieve SI following resection was associated with reduced RFS. Considering only those patients with an R0 resection, failure to achieve SI was associated with worse 3-year RFS compared with patients having SI (36% vs 80%; P = 0.006).

CONCLUSIONS:

Failure to achieve symptomatic improvement after resection of functional NETs is associated with worse RFS. These patients may benefit from short-interval surveillance imaging postoperatively to assess for earlier radiographical disease recurrence.

KEYWORDS:

VIPoma; gastrinoma; glucagonoma; insulinoma; recurrence; symptomatic

PMID:
30481383
DOI:
10.1002/jso.25306
[Indexed for MEDLINE]

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