Background
Non-functioning pancreatic neuroendocrine tumors (NFpNET) present with distant metastases in up to 50% of patients. It is unknown whether removal of the primary tumor in patients with NFpNET and metastases is beneficial.
Methods
We used the Surveillance, Epidemiology and End Results (SEER) database to identify patients with NFpNET and distant metastases. The primary outcome measure in this study was overall survival.
Results
We identified 882 patients with metastatic NFpNET and survival data. 303 (34%) patients had surgical removal of their primary tumor of which 243 (80%) were grade I or II. Median survival of patients undergoing surgery was 65 (95% CI: 60–86) versus 10 (8–12) months for those without surgery (p<0.0001). Patients diagnosed after 2003 (n=625, 71%) were more likely to undergo an operation than those diagnosed earlier (p=0.001). Multivariable analysis showed that lower tumor grade (p<0.0001), younger age (p<0.0001), diagnosis during or after 2003 (p=0.0003), tumor site in the body/tail (p=0.009) and surgical resection of the primary tumor site (p<0.0001) were significantly associated with prolonged survival of patients with NFpNET and distant metastases.
Conclusions
This study suggests that surgical removal of primary NFpNET is associated with longer survival in patients with distant metastases and could therefore be considered as a additional treatment option in this patient population.
Introduction:
Nexplanon is a 4 cm rod-shaped barium sulphate coated contraceptive implant with a usual subdermal insertion in the inner non-dominant upper arm. Complications proper to subdermal contraceptive implants are unusual and principally localized and minor, comprising infection at the site of implantation, hematoma, abnormal scar development, or local nerve and blood vessel injuries. Infrequently, contraceptive implant migration can happen, though habitually not far from the site of insertion. Pulmonary embolization of the device is remarkably rare and can present with symptoms such as chest pain or dyspnea.
Patient concerns and diagnosis:
We report one of the rare cases of asymptomatic Nexplanon pulmonary embolism in a 26-year-old female.
Interventions and outcomes:
An endovascular intervention successfully retrieved the device from the lateral segment right middle lobe pulmonary artery without any complications.
Conclusion:
Several cases of contraceptive implant migration into the pulmonary artery have been reported to this day. Preventing this life-threatening complication is challenging, and yet, no clear guidelines have been established.
Our study shows that RGS with (68)Ga-DOTATATE is feasible and correctly confirms bowel NETs and metastatic mesenteric lymph nodes. Further studies are needed to determine the benefit of RGS with (68)Ga-DOTATATE.
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