TY - JOUR
T1 - Implementation of Current ENETS Guidelines for Surgery of Small (≤2 cm) Pancreatic Neuroendocrine Neoplasms in the German Surgical Community: An Analysis of the Prospective DGAV StuDoQ|Pancreas Registry
AU - The StuDoQ|Pancreas study group and members of StuDoQ|Pancreas registry of the German Society for General and Visceral Surgery (DGAV)
AU - Mintziras, Ioannis
AU - Keck, Tobias
AU - Werner, Jens
AU - Fichtner-Feigl, Stefan
AU - Wittel, Uwe
AU - Senninger, Norbert
AU - Vowinkel, Thorsten
AU - Köninger, Jörg
AU - Anthuber, Matthias
AU - Geißler, Bernd
AU - Bartsch, Detlef Klaus
AU - Ghadimi, Michael
AU - Post, Stefan
AU - Wilhelm, Torsten J.
AU - Germer, Christoph Thomas
AU - Uhl, Waldemar
AU - Belyaev, Orlin
AU - Kraus, Thomas
AU - Witzigmann, Helmut
AU - Hommann, Merten
AU - Klar, Ernst
AU - Glanemann, Matthias
AU - Gutt, Carsten
AU - Manger, Thomas
AU - Krämling, Hans Jörg
AU - Kalff, Jörg C.
AU - Glowka, Tim R.
AU - Nüssler, Natascha C.
AU - Ritz, Jörg Peter
AU - Padberg, Winfried
AU - Kroesen, Anton J.
AU - Stier, Albrecht
AU - Lorenz, Dietmar
AU - Bechstein, Wolf Otto
AU - Oldhafer, Karl Jürgen
AU - Eisold, Sven
AU - Tröbs, Ute
AU - Reith, Hans Bernd
AU - Schumacher, Franz Josef
AU - Wagler, Elke
AU - Farkas, Stefan
AU - Klammer, Frank
AU - Schwarzbach, Matthias
AU - Niedergethmann, Marco
AU - Runkel, Norbert
AU - Piso, Pompiliu
AU - Lorenz, Eric P.M.
AU - Mönch, Christian
AU - Bieck, Steffanie
AU - Grützmann, Robert
PY - 2019/1/15
Y1 - 2019/1/15
N2 - Background: ENETS guidelines recommend parenchyma-sparing procedures without formal lymphadenectomy, ideally with a minimally invasive laparoscopic approach for sporadic small pNENs (≤2 cm). Non-functioning (NF) small pNENs can also be observed. The aim of the study was to evaluate how these recommendations are implemented in the German surgical community. Methods: Data from the prospective StuDoQ|Pancreas registry of the German Society of General and Visceral Surgery were analyzed regarding patient’s demographics, tumor characteristics, surgical procedures, histology and perioperative outcomes. Results: Eighty-four (29.2%) of 287 patients had sporadic pNENs ≤2 cm. Forty-three (51.2%) patients were male, and the mean age at diagnosis was 58.8 ± 15.6 years. Twenty-five (29.8%) pNENs were located in the pancreatic head. The diagnosis pNEN was preoperatively established in 53 (65%) of 84 patients. Sixty-two (73.8%) patients had formal pancreatic resections, including partial pancreaticoduodenectomy or total pancreatectomy (21.4%). Only 22 (26.2%) patients underwent parenchyma-sparing resections and 23 (27.4%) patients had minimally invasive procedures. A lymphadenectomy was performed in 63 (75.4%) patients, and lymph node metastases were diagnosed in 6 (7.2%) patients. Eighty-two (97.7%) patients had an R0 resection. Sixty (72%) tumors were classified G1, 24 (28%) tumors G2. Twenty-seven (32.2%) of 84 patients had postoperative relevant Clavien–Dindo grade ≥3 complications. Thirty- and 90-day mortalities were 2.4% and 3.6%. Conclusions: ENETS guidelines for surgery of small pNENs are yet not well accepted in the German surgical community, since the rate of formal resections with standard lymphadenectomy is high and the minimally invasive approach is underused. The attitude to operate small NF tumors seems to be rather aggressive.
AB - Background: ENETS guidelines recommend parenchyma-sparing procedures without formal lymphadenectomy, ideally with a minimally invasive laparoscopic approach for sporadic small pNENs (≤2 cm). Non-functioning (NF) small pNENs can also be observed. The aim of the study was to evaluate how these recommendations are implemented in the German surgical community. Methods: Data from the prospective StuDoQ|Pancreas registry of the German Society of General and Visceral Surgery were analyzed regarding patient’s demographics, tumor characteristics, surgical procedures, histology and perioperative outcomes. Results: Eighty-four (29.2%) of 287 patients had sporadic pNENs ≤2 cm. Forty-three (51.2%) patients were male, and the mean age at diagnosis was 58.8 ± 15.6 years. Twenty-five (29.8%) pNENs were located in the pancreatic head. The diagnosis pNEN was preoperatively established in 53 (65%) of 84 patients. Sixty-two (73.8%) patients had formal pancreatic resections, including partial pancreaticoduodenectomy or total pancreatectomy (21.4%). Only 22 (26.2%) patients underwent parenchyma-sparing resections and 23 (27.4%) patients had minimally invasive procedures. A lymphadenectomy was performed in 63 (75.4%) patients, and lymph node metastases were diagnosed in 6 (7.2%) patients. Eighty-two (97.7%) patients had an R0 resection. Sixty (72%) tumors were classified G1, 24 (28%) tumors G2. Twenty-seven (32.2%) of 84 patients had postoperative relevant Clavien–Dindo grade ≥3 complications. Thirty- and 90-day mortalities were 2.4% and 3.6%. Conclusions: ENETS guidelines for surgery of small pNENs are yet not well accepted in the German surgical community, since the rate of formal resections with standard lymphadenectomy is high and the minimally invasive approach is underused. The attitude to operate small NF tumors seems to be rather aggressive.
UR - http://www.scopus.com/inward/record.url?scp=85051292228&partnerID=8YFLogxK
UR - http://www.mendeley.com/research/implementation-current-enets-guidelines-surgery-small-2cm-pancreatic-neuroendocrine-neoplasms-german
U2 - 10.1007/s00268-018-4751-2
DO - 10.1007/s00268-018-4751-2
M3 - Journal articles
C2 - 30097704
AN - SCOPUS:85051292228
SN - 0364-2313
VL - 43
SP - 175
EP - 182
JO - World Journal of Surgery
JF - World Journal of Surgery
IS - 1
ER -
