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World J Surg. 2019 Aug 5. doi: 10.1007/s00268-019-05107-7. [Epub ahead of print]

One-Year Postoperative Mortality in MEN1 Patients Operated on Gastric and Duodenopancreatic Neuroendocrine Tumors: An AFCE and GTE Cohort Study.

Author information

1
Department of General, Digestive and Endocrine Surgery, Dupuytren University Hospital, Limoges, France.
2
Department of General, Digestive and Endocrine Surgery, Dupuytren University Hospital, Limoges, France. mathonnet@unilim.fr.
3
Chirurgie Digestive, Générale et Endocrinienne, CHU de Limoges - Hôpital Dupuytren, 87042, Limoges Cedex, France. mathonnet@unilim.fr.
4
Department of Pancreatic and Endocrine Surgery, Cochin University Hospital, APHP, Paris, France.
5
Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré Hospital, Reims-Champagne-Ardennes University, Reims, France.
6
Department of General and Digestive Surgery, Robert-Debré Hospital, Reims-Champagne-Ardennes University, Reims, France.
7
Department of Digestive Surgery, Jean-Bernard University Hospital, Poitiers, France.
8
Department of General, Digestive and Endocrine Surgery, University Hospital of Lyon Sud, Pierre-Bénite, France.
9
EA 7425 HESPER, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France.
10
Department of General and Endocrine Surgery, Pitié-Salpétrière University Hospital, APHP, Sorbonne University, Paris, France.
11
Department of Digestive and Endocrine Surgery, Hôtel-Dieu Hospital, CIC-IMAD, Nantes, France.
12
Department of Digestive Surgery, Toulouse University Hospital, Toulouse, France.
13
Department of General and Endocrine Surgery, Lille University Hospital, University of Lille, Lille, France.
14
Department of General and Endocrine Surgery, Lille University Hospital, INSERM U1190, University of Lille, Lille, France.
15
Department of Hepato-Pancreato-Biliary Surgery, Paris Diderot University, Beaujon Hospital, APHP, Clichy, France.
16
Department of Digestive and Endocrine Surgery, Dijon University Hospital, Dijon, France.
17
CIC1432, Clinical Epidemiology Unit, INSERM, Dijon, France.
18
Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Centre, Dijon-Bourgogne University Hospital, Dijon, France.

Abstract

IMPORTANCE:

In MEN1 patients with gastric and duodenopancreatic neuroendocrine tumors (GPD-NET), surgery aims to control secretions or to prevent metastatic spread, but after GPD-NET resection, postoperative mortality may be related to the surgery itself or to other associated MEN1 lesions with their own uncontrolled secretions or metastatic behavior.

OBJECTIVE:

To analyze the causes of death within 1 year following a GPD-NET resection in MEN1 patients.

DESIGN:

An observational study collecting data from the Groupe d'étude des Tumeurs Endocrines (GTE) database. The analysis considered the time between surgery and death (early deaths [<1 month after surgery] versus delayed deaths [beyond 1 month after surgery]) and the period (before 1990 vs after 1990). Causes of death were classified as related to GDP surgery, related to surgery for other MEN1 lesions or not related to MEN1 causes.

SETTING:

GTE database which includes 1220 MEN1 patients and 441 GPD-NET resections.

PARTICIPANTS:

Four hundred and forty-one GPD-NET resections.

MAIN OUTCOME MEASURES:

The primary end point was postoperative mortality within 1 year after surgery.

RESULTS:

Twenty-four patients met the inclusion criteria (2%). Median age at death was 50.5 years. Sixteen deaths occurred in the 30-day postoperative period (76%). Among the 8 delayed deaths, 3 occurred as a result of medical complications between 30 and 90 postoperative days. After 1990, mean age at death increased from 48 to 58 years (p = 0.09), deaths related to uncontrolled acid secretion disappeared (p < 0.001) and deaths related to associated MEN1 lesions increased from 8 to 54% (p = 0.16).

CONCLUSION:

Surgery and uncontrolled secretions remain the two main causes of death in MEN1 patients operated for a GPD-NET tumor. Improving the prognosis of these patients requires a strict evaluation of the secretory syndrome and MEN1 aggressiveness before GDP surgery.

PMID:
31384998
DOI:
10.1007/s00268-019-05107-7

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