小肠类癌手术的中心化需求：来自 GTE-Endocan-RENATEN 网络、中央 ChirSINET 研究的队列研究。
The Need for Centralization for Small Intestinal Neuroendocrine Tumor Surgery: A Cohort Study from the GTE-Endocan-RENATEN Network, the CentralChirSINET Study.
机构信息
Department of Digestive Surgery, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon Cedex 03, France.
Department of Digestive Surgery, Reims University Hospital, Robert Debré Hospital, Reims, France.
出版信息
Ann Surg Oncol. 2023 Dec;30(13):8528-8541. doi: 10.1245/s10434-023-14276-8. Epub 2023 Oct 9.
BACKGROUND
The concept of surgical centralization is becoming more and more accepted for specific surgical procedures.
OBJECTIVE
The aim of this study was to evaluate the relationship between procedure volume and the outcomes of surgical small intestine (SI) neuroendocrine tumor (NET) resections.
METHODS
We conducted a retrospective national study that included patients who underwent SI-NET resection between 2019 and 2021. A high-volume center (hvC) was defined as a center that performed more than five SI-NET resections per year. The quality of the surgical resections was evaluated between hvCs and low-volume centers (lvCs) by comparing the number of resected lymph nodes (LNs) as the primary endpoint.
RESULTS
A total of 157 patients underwent surgery in 33 centers: 90 patients in four hvCs and 67 patients in 29 lvCs. Laparotomy was more often performed in hvCs (85.6% vs. 59.7%; p < 0.001), as was right hemicolectomy (64.4% vs. 38.8%; p < 0.001), whereas limited ileocolic resection was performed in 18% of patients in lvCs versus none in hvCs. A bi-digital palpation of the entire SI length (95.6% vs. 34.3%, p < 0.001), a cholecystectomy (93.3% vs. 14.9%; p < 0.001), and a mesenteric mass resection (70% vs. 35.8%; p < 0.001) were more often performed in hvCs. The proportion of patients with ≥8 LNs resected was significantly higher (96.3% vs. 65.1%; p < 0.001) in hvCs compared with lvCs, as was the proportion of patients with ≥12 LNs resected (87.8% vs. 52.4%). Furthermore, the number of patients with multiple SI-NETs was higher in the hvC group compared with the lvC group (43.3% vs. 25.4%), as were the number of tumors in those patients (median of 7 vs. 2; p < 0.001).
CONCLUSIONS
Optimal SI-NET resection was significantly more often performed in hvCs. Centralization of surgical care of SI-NETs is recommended.
背景
对于某些特定的手术程序，手术集中化的概念越来越被接受。
目的
本研究旨在评估手术小肠（SI）神经内分泌肿瘤（NET）切除术的手术量与手术结果之间的关系。
方法
我们进行了一项回顾性的全国性研究，纳入了 2019 年至 2021 年间接受 SI-NET 切除术的患者。高容量中心（hvC）被定义为每年进行超过 5 例 SI-NET 切除术的中心。通过比较主要终点为切除的淋巴结（LNs）数量，评估 hvC 和低容量中心（lvC）之间的手术切除质量。
结果
共有 157 名患者在 33 个中心接受了手术：90 名患者在 4 个 hvC 中，67 名患者在 29 个 lvC 中。hvC 中更常进行剖腹手术（85.6% vs. 59.7%；p<0.001），右半结肠切除术（64.4% vs. 38.8%；p<0.001）更常见，而 lvC 中 18%的患者进行有限的回肠结肠切除术，而 hvC 中没有。hvC 中更常进行整个 SI 长度的双指触诊（95.6% vs. 34.3%；p<0.001）、胆囊切除术（93.3% vs. 14.9%；p<0.001）和肠系膜肿块切除术（70% vs. 35.8%；p<0.001）。hvC 中切除的淋巴结数量≥8 个的患者比例显著高于 lvC（96.3% vs. 65.1%；p<0.001），切除的淋巴结数量≥12 个的患者比例也显著高于 lvC（87.8% vs. 52.4%）。此外，hvC 组中多个 SI-NET 的患者比例高于 lvC 组（43.3% vs. 25.4%），且这些患者的肿瘤数量也更多（中位数为 7 个 vs. 2 个；p<0.001）。
结论
SI-NET 的最佳切除术在 hvC 中更为常见。建议集中手术治疗 SI-NET。
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