Background: 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. Methods: 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. Results: 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 18F-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 18F-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%. Conclusion: 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 18F-fluorodeoxyglucose positron emission tomography and cytologic grading, seems to be poorly accurate in determining malignant features in these small lesions.

Management of small asymptomatic nonfunctioning pancreatic neuroendocrine tumors: Limitations to apply guidelines into real life

Partelli S.;Mazza M.;Andreasi V.;Crippa S.;Falconi M.
2019-01-01

Abstract

Background: 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. Methods: 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. Results: 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 18F-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 18F-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%. Conclusion: 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 18F-fluorodeoxyglucose positron emission tomography and cytologic grading, seems to be poorly accurate in determining malignant features in these small lesions.
2019
Aged
Cohort Studies
Female
Guideline Adherence
Humans
Incidental Findings
Male
Middle Aged
Neoplasm Invasiveness
Neoplasm Staging
Pancreatectomy
Pancreatic Neoplasms
Positron-Emission Tomography
Practice Guidelines as Topic
Prognosis
Retrospective Studies
Risk Assessment
Survival Rate
Watchful Waiting
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.11768/108869
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