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Surgery or active surveillance for pNETs < 2 cm: preliminary results from a single center Brazilian cohort.
Surgery and active surveillance have been recommended as therapeutic options for small pancreatic neuroendocrine tumors (pNETS). The appropriateness and safety of both treatment modalities have been debated in the literature and no series about this issue can be found considering Brazilian population.
Analyze safety and preliminary results of surgical resection and active surveillance for non-functional, non-metastatic pNETs with two centimeters or less in a Brazilian single center cohort
A retrospective cohort study with review of medical charts from patients with pancreatic neuroendocrine tumors with 2 cm or less admitted to our center from 2002 to 2020 was performed. Clinical and radiological characteristics as well as differentiation and surgical outcomes for those submitted to resection were recorded. Patients with multicentric or metastatic disease, poorly differentiated histology were excluded.
A total of 64 patients were analysed, 41 in the surgical approach group and 23 in the active surveillance group. Median age was 57(46-62) and 61(52-74) respectively (p =0.096). Tumor size was comparable in the two groups median diameter 14(10-170)mm vs 12(10-15);p = 0.53. In contrast, tumors located in the head of the pancreas were more common in the surveillance than in the surgery group 41% vs 17%(p=0,038). Most patients in this latter cohort underwent an MRI and Gallium-68 PET-CT when compared to the surgical one. An endoscopic ultrasound-guided biopsy was performed in 17 (73%) of patients in the surveillance group with an effectivity of 70.59% in determining tumor grade whereas only 26(63,41%) of patients in the surgery group received a preoperative biopsy. In the surgical approach group, perioperative morbidity rate was 29% and the most common surgical complication was abdominal infection with 22%. Median hospital stay was 8 days (3-23) and there was no mortality. Minimally invasive surgery was performed in 80,1% of patients with 12,1% robotic.The median follow-up period was 38.6 months in the surveillance group and 46.4 months in the surgical cohort. No patient developed disease progression or recurrence. One patient in the active surveillance group decided to undergo surgery after a 1 year follow-up period, by personal choice.
Our findings suggest that both approaches are safe and acceptable for patients with pNETs < 2.0 cm. Long-term outcome and quality of life should be considered when discussing such options with patients.
surgery , pancreatic neuroendocrine tumors , active surveilance
DANTE ALTENFELDER SILVA, GUSTAVO HENKLAIN, ALEX DE ALBUQUERQUE LIMA BARBOSA, SILVIO TORRES, ANDRE GODOY, IGOR CORREIA DE FARIAS , ALESSANDRO LANDSKRON DINIZ, WILSON COSTA JUNIOR, HEBER SALVADOR RIBEIRO, FELIPE JOSE FERNADES COIMBRA