Lodato Francesca, Gazzola Alessia, Signoretti Marco, Mastrangelo Laura, Gaetani Luca, Landi Stefano, Puglisi Silvana Bernadetta, Jovine Elio, Cennamo Vincenzo
Department of Surgery, Unit of Gastroenterology and Interventional Endoscopy, AUSL Bologna Bellaria-Maggiore Hospital.
Gastroenterology Unit, Santa Maria delle Croci Hospital, Ravenna.
Eur J Gastroenterol Hepatol. 2025 Jul 1;37(7):826-832. doi: 10.1097/MEG.0000000000002997. Epub 2025 May 1.
Pancreatic neuroendocrine tumours (pNETs) are rapidly increasing. Their management implies considerable resources. Multidisciplinary discussion of tumours has become a cornerstone in clinical oncology but no studies demonstrate a clear clinical benefit. The aim of the present study is to evaluate whether the systematic discussion of patients with pNET in multidisciplinary meeting (MM) has changed their management.
This retrospective single-centre study was held from 2004 to 2023. Since 2018 all patients were discussed in MM; thus, they were divided into two groups (board and no board) to evaluate clinical and surgical outcomes and whether multidisciplinary discussion improved adherence to guidelines.
A total of 128 patients were enrolled (55 board group and 73 no board). Groups were comparable for gender (36.4% female vs. 45.2%), mean age (60.3 vs. 61.7 years), mean American Society of Anesthesiologists score (2.66 vs. 2.71), Charlson Comorbidity Index (CCI) (CCI < 6, 80 vs. 79.45%), rate of functioning tumours (7.3 vs. 16.4%, P = 0.2), and pre/postoperative grading. Endoscopic ultrasound (EUS) was used more in board vs. no board (EUS: 90.9 vs. 71.2%, P = 0.005, EUS with fine-needle aspiration 89.1 vs. 65.8%, P = 0.002). More patients underwent surgery in no board (78.1 vs. 61.8%, P = 0.045). Postoperative complications were comparable as well as mortality (9.1 vs. 9.6%) and adherence to guidelines (board vs no board adherents: 90.3 vs. 87.6%, P = 0.9).
Systematic multidisciplinary discussion does not result in significant clinical impact in terms of surgical complications, recurrences, and reinterventions. A selective approach in multidisciplinary discussion would be worth considering.
胰腺神经内分泌肿瘤（pNETs）的发病率正在迅速上升。其治疗需要大量资源。肿瘤的多学科讨论已成为临床肿瘤学的基石，但尚无研究表明其具有明确的临床益处。本研究的目的是评估在多学科会议（MM）中对pNET患者进行系统性讨论是否改变了他们的治疗方式。
这项回顾性单中心研究于2004年至2023年进行。自2018年起，所有患者均在MM中进行讨论；因此，将他们分为两组（参与讨论组和未参与讨论组），以评估临床和手术结果，以及多学科讨论是否提高了对指南的依从性。
共纳入128例患者（参与讨论组55例，未参与讨论组73例）。两组在性别（女性分别为36.4%和45.2%）、平均年龄（分别为60.3岁和61.7岁）、平均美国麻醉医师协会评分（分别为2.66和2.71）、查尔森合并症指数（CCI）（CCI＜6，分别为80%和79.45%）、功能性肿瘤发生率（分别为7.3%和16.4%，P = 0.2）以及术前/术后分级方面具有可比性。参与讨论组比未参与讨论组更多地使用内镜超声（EUS）（EUS：90.9%对71.2%，P = 0.005；EUS引导下细针穿刺活检：89.1%对65.8%，P = 0.002）。未参与讨论组接受手术的患者更多（78.1%对61.8%，P = 0.045）。术后并发症、死亡率（分别为9.1%和9.6%）以及对指南的依从性具有可比性（参与讨论组与未参与讨论组的依从率：90.3%对87.6%，P = 0.9）。
系统性多学科讨论在手术并发症、复发和再次干预方面未产生显著临床影响。值得考虑采用选择性多学科讨论方法。
