Annals of Surgery Open (Mar 2022)

Benefit of Primary Tumor Resection in Stage IV, Grade 1 and 2, Pancreatic Neuroendocrine Tumors

  • Josefine Kjaer, MD,
  • Thomas E. Clancy, MD,
  • Anders Thornell, MD, PhD,
  • Niklas Andersson, MD,
  • Per Hellman, MD, PhD,
  • Joakim Crona, MD, PhD,
  • Staffan Welin, MD, PhD,
  • Megan Sulciner, MD,
  • Brittany Powell, MD,
  • Lauren Brais, MPH,
  • Kristina Astone, MPH,
  • William Baddoo, BA,
  • Gerhard Doherty, MD,
  • Jennifer A. Chan, MD, MPH,
  • Olov Norlén, MD, PhD,
  • Peter Stålberg, MD, PhD

DOI
https://doi.org/10.1097/AS9.0000000000000151
Journal volume & issue
Vol. 3, no. 1
p. e151

Abstract

Read online

Objective:. To determine the association of primary tumor resection in stage IV pancreatic neuroendocrine tumors (Pan-NET) and survival in a propensity-score matched study. Background:. Pan-NET are often diagnosed with stage IV disease. The oncologic benefit from primary tumor resection in this scenario is debated and previous studies show contradictory results. Methods:. Patients from 3 tertiary referral centers from January 1, 1985, through December 31, 2019: Uppsala University Hospital (Uppsala, Sweden), Sahlgrenska University Hospital (Gothenburg, Sweden), and Brigham and Women’s Hospital/Dana-Farber Cancer Institute (Boston, USA) were assessed for eligibility. Patients with sporadic, grade 1 and 2, stage IV pan-NET, with baseline 2000–2019 were divided between those undergoing primary tumor resection combined with oncologic treatment (surgery group [SG]), and those who received oncologic treatment without primary tumor resection (non-SG). A propensity-score matching was performed to account for the variability in the extent of metastatic disease and comorbidity. Primary outcome was overall survival. Results:. Patients with stage IV Pan-NET (n = 733) were assessed for eligibility, 194 were included. Patients were divided into a SG (n = 65) and a non-SG (n = 129). Two isonumerical groups with 50 patients in each group remained after propensity-score matching. The 5-year survival was 65.4% (95% CI, 51.5-79.3) in the matched SG and 47.8% (95% CI, 30.6-65.0) in the matched non-SG (log-rank, P = 0.043). Conclusions:. Resection of the primary tumor in patients with stage IV Pan-NET and G1/G2 grade was associated with prolonged overall survival compared to nonoperative management. A surgically aggressive regime should be considered where resection is not contraindicated.