Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy; Vita e Salute University, Milan, Italy.
Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy.
Surgery. 2019 Aug;166(2):157-163. doi: 10.1016/j.surg.2019.04.003. Epub 2019 May 17.
International guidelines suggest a watchful strategy for small nonfunctioning pancreatic neuroendocrine tumors. The aim of this study was to evaluate the management and indications for surgery in patients with asymptomatic nonfunctioning pancreatic neuroendocrine tumors ≤2 cm.
Patients with asymptomatic, incidental, sporadic nonfunctioning pancreatic neuroendocrine tumors ≤2 cm without nodal or distant metastases were included (2012-2016). A comparison between active surveillance and surgery groups was performed.
Of the 101 included patients, 72% underwent active surveillanc and 28% were surgically treated. Patients submitted to surgery were significantly younger (53 vs 60 years, P = .013), had a higher incidence of positive F-fluorodeoxyglucose positron emission tomography (18% vs 50%, P = .003), and a higher incidence of cytologically determined G2 tumor (0% vs 14%, P = .008). Conservatively managed patients had a significantly smaller tumor size (12 vs 16 mm, P = .0001). The main reasons determining surgical choice were as follows: patient's preference (32%), positive F-fluorodeoxyglucose positron emission tomography (21.5%), main pancreatic duct dilation (17.5%), cytologically determined G2 tumor (14.5%), and young age (14.5%). At a median follow-up of 40 months, all of the 73 patients conservatively managed were alive, with no evidence of distant metastases and none underwent surgery. Only 5 patients had a tumor growth >20%.
One-third of patients with asymptomatic small nonfunctioning pancreatic neuroendocrine tumors ≤2 cm underwent surgery. Patient's preference, initial tumor size, and young age were the main determinants of surgical indication. Preoperative diagnostic workup, including F-fluorodeoxyglucose positron emission tomography and cytologic grading, seems to be poorly accurate in determining malignant features in these small lesions.
国际指南建议对小的无功能性胰腺神经内分泌肿瘤采取观察策略。本研究旨在评估无功能性胰腺神经内分泌肿瘤≤2cm 且无症状患者的管理和手术适应证。
纳入了 2012 年至 2016 年间诊断为无症状、偶然发现、散发性无功能性胰腺神经内分泌肿瘤且肿瘤直径≤2cm 且无淋巴结或远处转移的患者。对主动监测组和手术组进行了比较。
在纳入的 101 例患者中，72%的患者接受了主动监测，28%的患者接受了手术治疗。手术组患者明显更年轻（53 岁比 60 岁，P=0.013），正电子发射断层扫描术（positron emission tomography，PET）-氟代脱氧葡萄糖（fluorodeoxyglucose，FDG）阳性率更高（18%比 50%，P=0.003），细胞学分级为 G2 的肿瘤比例更高（0%比 14%，P=0.008）。接受保守治疗的患者肿瘤直径明显更小（12mm 比 16mm，P=0.0001）。决定手术选择的主要原因如下：患者意愿（32%）、FDG-PET 阳性（21.5%）、主胰管扩张（17.5%）、细胞学分级为 G2（14.5%）和年龄较小（14.5%）。中位随访 40 个月时，所有 73 例接受保守治疗的患者均存活，无远处转移，也无一例接受手术。仅 5 例肿瘤生长超过 20%。
三分之一的无症状小的无功能性胰腺神经内分泌肿瘤≤2cm 患者接受了手术治疗。患者意愿、初始肿瘤大小和年龄是手术适应证的主要决定因素。包括 FDG-PET 和细胞学分级在内的术前诊断检查在确定这些小病变的恶性特征方面似乎准确性较差。
