Are Cystic Pancreatic Neuroendocrine Tumors an Indolent Entity Results from a Single-Center Surgical Series

Abstract

Introduction: Cystic pancreatic neuroendocrine tumors (CPanNETs) represent an uncommon variant of pancreatic neuroendocrine tumors (PanNETs). Due to their rarity, there is a lack of knowledge with regard to clinical features and postoperative outcome. Methods: The prospectively maintained surgical database of a high-volume institution was queried, and 46 resected CPanNETs were detected from 1988 to 2015. Clinical, demographic, and pathological features and survival outcomes of CPanNETs were described and matched with a population of 92 solid PanNETs (SPanNETs) for comparison. Results: CPanNETs accounted for 7.8% of the overall number of resected PanNETs (46/587). CPanNETs were mostly sporadic (n = 42, 91%) and nonfunctioning (39%). Two functioning CPanNETs were detected (4.3%), and they were 2 gastrinomas. The median tumor diameter was 30 mm (range 10-120). All tumors were well differentiated, with 38 (82.6%) G1 and 8 (17.4%) G2 tumors. Overall, no CPanNET showed a Ki-67 >5%. A correct preoperative diagnosis of a CPanNET was made in half of the cases. After a median follow-up of >70 months, the 5- and 10-year overall survival of resected CPanNETs was 93.8 and 62.5%, respectively, compared to 92.7 and 84.6% for SPanNETs (p > 0.05). The 5- and 10-year disease-free survival rates were 94.5 and 88.2% for CPanNETs and 81.8 and 78.9% for SPanNETs, respectively (p > 0.05). Conclusion: In the setting of a surgical cohort, CPanNETs are rare, nonfunctional, and well-differentiated neoplasms. After surgical resection, they share the excellent outcome of their well-differentiated solid counterparts for both survival and recurrence.

Neuroendokrynne torbielowate nowotwory trzustki — punkt widzenia gastroenterologa

“…In the largest comparative studies of Bordeianou et al and Koh et al there was no significant difference in five-year survival between solid and cystic neuroendocrine tumours [17,18]. However, in the study of Paiella et al on 46 resected CPNETs, the tumours were well differentiated (G1, G2-less likely) and there was no lesion with Ki67 index over 5% [25]. Another proof of relatively indolent behaviour is the retrospective analysis of Cloyd et al, in which there were no cases of purely cystic neuroendocrine tumours with metastases, recurrence, or death caused by the disease in patients after surgery [24].…”

Reply to: Impact of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy

“…In fact, propensity score matching (PSM) analysis has been generally used in retrospective observational studies, which enables better balance between groups across all potential risk factors and evaluates the extent of balanced match in a measurable approach. 2,3 This method could be used in further studies based on the valuable data in the present study. Actually, a study published in 2018 investigated a similar topic using this method, but reached an opposite conclusion.…”

“…Additionally, the surgeon decision wasn't influenced by the tumor size or the performance status, evaluated by Charlson and American Society of Anaesthesiologists score as reported; instead the resectability of the lesion guided the surgical decision. Propensity score matching has been already adopted several times by our institution 2,3 and it is a well-known statistical method to reduce confounding factors when comparing different groups. The cohort considered is one of the largest ever published on the topic so far; for this reason it was believed that the sample size would have reduced the impact of most of the possible confounding factors.…”

“…Esophageal endoscopic submucosal dissection (ESD) for large lesions has a risk of post-ESD stricture. 1,2 Local triamcinolone injection 3 or filling 4 are reportedly useful to reduce the incidence of post-ESD stricture, but strictures requiring balloon dilation can occur. 3,4 Although oral prednisolone may be more effective than local triamcinolone, 5 it raises concerns regarding adverse effects.…”

“…Ju-Dong Li,1,2 Xin-Fei Xu1,2 and Tian Yang1 1 Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, and 2 Department of Clinical Medicine, Second Military Medical University, Shanghai, China Ju-Dong Li and Xin-Fei Xu contributed equally to this work. doi: 10.1111/den.13234…”