Management of Nonfunctional Pancreatic Neuroendocrine Tumors by Endoscopic Ultrasound-Guided Radiofrequency Ablation: A Retrospective Study in Two Tertiary Centers

Marx, M.; Godat, Sébastien; Caillol, Fabrice; Poizat, Flora; Ratone, JP; Pesenti, Christian; Schoepfer, A; Hoibian, Solène; Dahel, Yanis; Giovannini, M

doi:10.1055/s-0042-1744579

Cited by 3 publications

(2 citation statements)

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“…Radiofrequency ablation (RFA) has been used for the treatment of nonfunctional pancreatic neuroendocrine tumors (PNETs) < 2 cm 1 , functional PNETs (insulinoma) 2 , pancreatic metastasis of kidney cancer 3 , and isolated cases of intraductal papillary mucinous neoplasm (IPMN) with worrisome features 4 . We describe the use of RFA to treat a compressive cervical lymph node causing dysphagia ( Video 1 ).…”

Section: Endoscopy E-videosmentioning

confidence: 99%

Radiofrequency ablation of malignant cervical lymph nodes: an unusual treatment for dysphagia

et al. 2022

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Section: Endoscopy E-videosmentioning

confidence: 99%

Radiofrequency ablation of malignant cervical lymph nodes: an unusual treatment for dysphagia

et al. 2022

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“…These patients had lesion diameter of 10, 10, and 9 mm and an age ranging from 58 to 66. 1 Was performance of EUS-RFA indicated in these patients? The European Neuroendocrine Tumor Society guidelines recommends surveillance in patients with lesions <20 mm.…”

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confidence: 99%

Endoscopic ultrasound‐guided radiofrequency ablation for nonfunctional pancreatic neuroendocrine tumors: Put the gun away or keep shooting?

Rimbaș

Tripodi

Larghi

2022

Digestive Endoscopy

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We read with great interest the retrospective study by Marx et al. 1 reporting endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) treatment in 27 patients with sporadic, G1, nonfunctional pancreatic neuroendocrine tumors (NF-pNETs) (mean lesion size 14 AE 4.6 mm). There was a 93% complete response, with three cases of severe acute pancreatitis (11.1%), which evolved into a pancreatic fluid collection requiring EUS-guided drainage. These patients had lesion diameter of 10, 10, and 9 mm and an age ranging from 58 to 66. 1 Was performance of EUS-RFA indicated in these patients? The European Neuroendocrine Tumor Society guidelines recommends surveillance in patients with lesions <20 mm. However, the level of evidence beyond this conclusion is extremely low. 2 Conversely, in surgical series, about 30% of small NF-pNETs are operated, with serious adverse events (AEs) in 18-32% of cases. 3,4 EUS-RFA has been proposed as a minimally invasive alternative to surgery. When a new therapeutic modality is introduced, proper patient selection is critical in order to preserve your gun from a rapid and irreversible failure. In our opinion, this was not the case in the paper by Marx et al., 1 where grade III AEs ocurred in NF-pNETs ≤10 mm, which may never ever grow up and in which control of RFA current dispersion might be difficult, also if the smallest 5 mm needle was utilized, as we assume.A recent systematic review has reported 93% effectiveness and no major AEs (mean lesion size 16 mm). 5 If this is the case, we believe we should keep shooting EUS-RFA for small selected NF-pNETs, with size ranging from 14-15 to 20 mm, especially those located in the pancreatic head, while balancing other patient and lesion variables. 2 With this in mind, these patients should be offered EUS-RFA, surveillance and surgery to make them able to take their most appropriate personal decision.

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Enucleation Is a Feasible Procedure for Well-Differentiated pNEN—A Matched Pair Analysis

Nießen

Bechtiger

Hinz

et al. 2022

Cancers

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The extent of surgical resection in the treatment of pancreatic neuroendocrine neoplasms (pNEN) is still controversial. This study aimed to evaluate the outcomes of enucleation for well-differentiated non-functional (nf) pNEN. Patients undergoing enucleation (2001–2020) were analyzed. Clinicopathological parameters, perioperative outcomes and survival were assessed. The analysis was performed as a nested case-control study and matched-pair analysis with formal resection. Sixty-one patients undergoing enucleation were identified. Compared to patients undergoing formal resection, enucleation was associated with a significantly shorter median length of operative time (128 (IQR 95–170) versus 263 (172–337) minutes, p < 0.0001) and a significantly lower rate of postoperative diabetes (2% versus 21%, p = 0.0020). There was no significant difference in postoperative pancreatic fistula rate (18% versus 16% type B/C, p = 1.0), Clavien−Dindo ≥ III complications (20% versus 26%, p = 0.5189), readmission rate (12% versus 15%, p = 0.6022) or length of hospital stay (8 (7–11) versus 10 (8–17) days, p = 0.0652). There was no 30-day mortality after enucleation compared to 1.6% (n = 1) after formal resection. 10-year overall survival (OS) and disease-free survival (DFS) was similar between the two groups (OS: 89% versus 77%, p = 0.2756; DFS: 98% versus 91%, p = 0.0873). Enucleation presents a safe surgical approach for well-differentiated nf-pNEN with good long-term outcomes for selected patients.

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Management of Nonfunctional Pancreatic Neuroendocrine Tumors by Endoscopic Ultrasound-Guided Radiofrequency Ablation: A Retrospective Study in Two Tertiary Centers

Cited by 3 publications

References 0 publications

Radiofrequency ablation of malignant cervical lymph nodes: an unusual treatment for dysphagia

Radiofrequency ablation of malignant cervical lymph nodes: an unusual treatment for dysphagia

Endoscopic ultrasound‐guided radiofrequency ablation for nonfunctional pancreatic neuroendocrine tumors: Put the gun away or keep shooting?

Enucleation Is a Feasible Procedure for Well-Differentiated pNEN—A Matched Pair Analysis

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