Postlewait Lauren M, Ethun Cecilia G, Baptiste Gillian G, Le Nina, McInnis Mia R, Cardona Kenneth, Russell Maria C, Sarmiento Juan M, Kooby David A, Staley Charles A, Maithel Shishir K
Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
Division of General Surgery, Department of Surgery, Emory University, Atlanta, Georgia.
J Surg Oncol. 2016 Sep;114(4):440-5. doi: 10.1002/jso.24338. Epub 2016 Jun 22.
Enucleation and anatomic resection (central, distal, or pancreaticoduodenectomy) are surgical options for pancreatic neuroendocrine tumors. Depending on nodal-status, enucleation alone may not be oncologically appropriate. Preoperative factors predictive of nodal-involvement are not well defined.
Patients who underwent curative-intent enucleation or resection of non-metastatic, well/moderately differentiated tumors at a single institution (2000-2014) were included. The aim was to determine factors associated with nodal-metastases and recurrence-free survival.
Of 195 patients undergoing resection, 164 met inclusion-criteria. Lymphadenectomy was performed in 131 (80%), and 32 (24%) had nodal-metastases. Receiver-operative-characteristics analysis revealed tumor size ≥2 cm was associated with nodal-involvement (AUC: 0.689; Sensitivity: 90%; Specificity: 53%). On multivariable analysis, male gender (OR: 3.16; 95%CI: 1.18-8.46; P = 0.02), head/uncinate location (HR: 5.37; 95%CI: 2.07-13.96; P = 0.001), and size ≥2 cm (HR: 6.52; 95%CI: 1.75-24.30; P = 0.005) were associated with nodal-positivity. Nodal-metastases (HR: 3.04; 95%CI: 1.04-8.91; P = 0.043) and advanced T-stage (HR: 5.39; 95%CI: 1.46-19.95; P = 0.012) were independently associated with decreased recurrence-free survival. Enucleation (n = 17; 10%) had more positive margins and similar complication rates, pancreatic fistula rates, and lengths of stay as anatomic resections.
For pancreatic neuroendocrine tumors, male gender, head/uncinate location, and size ≥2 cm are associated with nodal-metastases. Nodal involvement is associated with decreased recurrence-free survival. Anatomic resection may be preferred in patients with these characteristics, as enucleation alone may under-stage patients and does not appear to be associated with an improved complication profile. J. Surg. Oncol. 2016;114:440-445. © 2016 Wiley Periodicals, Inc.
眼球摘除术和解剖性切除术（中央、远端或胰十二指肠切除术）是胰腺神经内分泌肿瘤的手术选择。根据淋巴结状态，仅行眼球摘除术在肿瘤学上可能并不合适。预测淋巴结受累的术前因素尚不明确。
纳入在单一机构（2000 - 2014年）接受根治性眼球摘除术或非转移性、高/中分化肿瘤切除术的患者。目的是确定与淋巴结转移和无复发生存相关的因素。
195例行切除术的患者中，164例符合纳入标准。131例（80%）进行了淋巴结清扫，32例（24%）有淋巴结转移。受试者工作特征分析显示肿瘤大小≥2 cm与淋巴结受累相关（曲线下面积：0.689；敏感性：90%；特异性：53%）。多变量分析显示，男性（比值比：3.16；95%置信区间：1.18 - 8.46；P = 0.02）、头部/钩突部位置（风险比：5.37；95%置信区间：2.07 - 13.96；P = 0.001）和大小≥2 cm（风险比：6.52；95%置信区间：1.75 - 24.30；P = 0.005）与淋巴结阳性相关。淋巴结转移（风险比：3.04；95%置信区间：1.04 - 8.91；P = 0.043）和晚期T分期（风险比：5.39；95%置信区间：1.46 - 19.95；P = 0.012）与无复发生存期缩短独立相关。眼球摘除术（n = 17；10%）切缘阳性更多，并发症发生率、胰瘘发生率和住院时间与解剖性切除术相似。
对于胰腺神经内分泌肿瘤，男性、头部/钩突部位置和大小≥2 cm与淋巴结转移相关。淋巴结受累与无复发生存期缩短相关。对于具有这些特征的患者，解剖性切除术可能更可取，因为仅行眼球摘除术可能会使患者分期不足，且似乎与改善并发症情况无关。《外科肿瘤学杂志》2016年；114：440 - 445。©2016威利期刊公司
