MEN1 患者胃和胰十二指肠神经内分泌肿瘤手术后一年的死亡率：AFCE 和 GTE 队列研究。

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

机构信息

Department of General, Digestive and Endocrine Surgery, Dupuytren University Hospital, Limoges, France.

Chirurgie Digestive, Générale et Endocrinienne, CHU de Limoges - Hôpital Dupuytren, 87042, Limoges Cedex, France.

出版信息

World J Surg. 2019 Nov;43(11):2856-2864. doi: 10.1007/s00268-019-05107-7.

DOI:10.1007/s00268-019-05107-7

PMID:31384998

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.

摘要

重要性

在 MEN1 患者的胃和十二指肠胰腺神经内分泌肿瘤（GPD-NET）中，手术旨在控制分泌或防止转移扩散，但在 GPD-NET 切除后，术后死亡率可能与手术本身或其他相关 MEN1 病变有关，这些病变会导致不受控制的分泌或转移行为。

目的

分析 MEN1 患者 GPD-NET 切除术后 1 年内死亡的原因。

设计

一项观察性研究，从 Groupe d'étude des Tumeurs Endocrines (GTE) 数据库中收集数据。分析考虑了手术和死亡之间的时间（早期死亡[手术后 1 个月内]与晚期死亡[手术后 1 个月后]）和时期（1990 年前与 1990 年后）。死亡原因分为与 GDP 手术相关、与其他 MEN1 病变相关或与 MEN1 无关。

地点

包含 1220 名 MEN1 患者和 441 例 GPD-NET 切除术的 GTE 数据库。

参与者

441 例 GPD-NET 切除术。

主要观察指标

主要终点是术后 1 年内的术后死亡率。

结果

符合纳入标准的患者有 24 例（2%）。死亡时的中位年龄为 50.5 岁。16 例死亡发生在术后 30 天内（76%）。在 8 例延迟死亡中，有 3 例是在术后 30 至 90 天发生医疗并发症导致的。1990 年后，死亡时的平均年龄从 48 岁增加到 58 岁（p=0.09），与未控制的胃酸分泌相关的死亡消失（p<0.001），与相关 MEN1 病变相关的死亡从 8%增加到 54%（p=0.16）。