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Langenbeck's Archives of Surgery

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Open Access 01-03-2020 | Metastasis | Original Article

Complications of surgery for gastro-entero-pancreatic neuroendocrine neoplasias

Authors: Max B. Albers, Martin Almquist, Anders Bergenfelz, Erik Nordenström

Published in: Langenbeck's Archives of Surgery | Issue 2/2020

Abstract

Purpose

Surgery is recommended for most patients with gastro-entero-pancreatic neuroendocrine neoplasias (GEP-NENs). Rates of complications and perioperative mortality have been reported in few mostly retrospective single-center series, but there has been no detailed analysis on risk factors for perioperative complications and mortality to date.

Methods

Data of patients with GEP-NENs operated between January 2015 and September 2018 were retrieved from EUROCRINE©, a European online endocrine surgical quality registry, and analyzed regarding rate and risk factors of surgical complications. Risk factors were assessed by logistic regression.

Results

Some 376 patients (211 female, 167 male; age median 63, range 15–89 years) were included. Most NENs were located in the small intestine (SI) (n = 132) or pancreas (n = 111), the rest in the stomach (n = 34), duodenum (n = 30), appendix (n = 30), colon, and rectum (n = 22), or with unknown primary (n = 15). Of the tumors, 320 (85.1%) were well or moderately differentiated, and 147 (39.1%) of the patients had distant metastases at the time of operation. Severe complications (Dindo-Clavien ≥ 3) occurred in 56 (14.9%) patients, and 4 (1.1%) patients died perioperatively. Severe complications were more frequent in surgery for duodenopancreatic NENs (n = 31; 22.0%) compared with SI-NENs (n = 15; 11.4%) (p = 0.014), in patients with lymph node metastases operated with curative aim of surgery (n = 24; 21.4%) versus non-metastasized tumors or palliative surgery (n = 32; 12.1%) (p = 0.020), and in functioning tumors (n = 20; 23.0%) versus non-functioning tumors (n = 30; 13.5%) (p = 0.042). Complication rates were not significantly associated with tumor stage or grade.

Conclusions

Severe complications are frequent in GEP-NEN surgery. Besides duodenopancreatic tumor location, curative resection of nodal metastases and functioning tumors are risk factors for complications.

Oberndorfer S (1907) Karzinoide Tumoren des Dünndarms. Frankfurter Zeitschrift für Pathologie 1:426–429

Lloyd RV, Osamura RY, Klöppel G, Rosai J (2017) WHO Classification of Tumours of Endocrine Organs, vol 10, 4th edn. IARC Press, Lyon

Dasari A, Shen C, Halperin D, Zhao B, Zhou S, Xu Y, Shih T, Yao JC (2017) Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States. JAMA Oncol 3(10):1335–1342. https://doi.org/10.1001/jamaoncol.2017.0589 CrossRefPubMedPubMedCentral

Kruljac I, Vurnek I, Maasberg S, Kust D, Blaslov K, Ladika Davidovic B, Stefanovic M, Demirovic A, Biscanin A, Filipovic-Cugura J, Maric Brozic J, Pape UF, Vrkljan M (2018) A score derived from routine biochemical parameters increases the diagnostic accuracy of chromogranin A in detecting patients with neuroendocrine neoplasms. Endocrine 60(3):395–406. https://doi.org/10.1007/s12020-018-1592-6 CrossRefPubMed

Kvols LK, Brendtro KL, North American Neuroendocrine Tumor S (2010) The North American Neuroendocrine Tumor Society (NANETS) guidelines: mission, goals, and process. Pancreas 39(6):705–706. https://doi.org/10.1097/MPA.0b013e3181eb7451 CrossRefPubMed

Strosberg JR, Coppola D, Klimstra DS, Phan AT, Kulke MH, Wiseman GA, Kvols LK, North American Neuroendocrine Tumor S (2010) The NANETS consensus guidelines for the diagnosis and management of poorly differentiated (high-grade) extrapulmonary neuroendocrine carcinomas. Pancreas 39(6):799–800. https://doi.org/10.1097/MPA.0b013e3181ebb56f CrossRefPubMedPubMedCentral

Niederle B, Pape UF, Costa F, Gross D, Kelestimur F, Knigge U, Oberg K, Pavel M, Perren A, Toumpanakis C, O’Connor J, O’Toole D, Krenning E, Reed N, Kianmanesh R, Vienna Consensus Conference p (2016) ENETS consensus guidelines update for neuroendocrine neoplasms of the jejunum and ileum. Neuroendocrinology 103(2):125–138. https://doi.org/10.1159/000443170 CrossRefPubMed

Falconi M, Eriksson B, Kaltsas G, Bartsch DK, Capdevila J, Caplin M, Kos-Kudla B, Kwekkeboom D, Rindi G, Kloppel G, Reed N, Kianmanesh R, Jensen RT, Vienna Consensus Conference p (2016) ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors. Neuroendocrinology 103(2):153–171. https://doi.org/10.1159/000443171 CrossRefPubMed

O’Toole D, Kianmanesh R, Caplin M (2016) ENETS 2016 consensus guidelines for the management of patients with digestive neuroendocrine tumors: an update. Neuroendocrinology 103(2):117–118. https://doi.org/10.1159/000443169 CrossRefPubMed

10.

Pavel M, O’Toole D, Costa F, Capdevila J, Gross D, Kianmanesh R, Krenning E, Knigge U, Salazar R, Pape UF, Oberg K, Vienna Consensus Conference p (2016) ENETS consensus guidelines update for the management of distant metastatic disease of intestinal, pancreatic, bronchial neuroendocrine neoplasms (NEN) and NEN of unknown primary site. Neuroendocrinology 103 (2):172–185. doi:https://doi.org/10.1159/000443167 CrossRefPubMed

11.

Pape UF, Niederle B, Costa F, Gross D, Kelestimur F, Kianmanesh R, Knigge U, Oberg K, Pavel M, Perren A, Toumpanakis C, O’Connor J, Krenning E, Reed N, O’Toole D, Vienna Consensus Conference p (2016) ENETS consensus guidelines for neuroendocrine neoplasms of the appendix (excluding goblet cell carcinomas). Neuroendocrinology 103 (2):144–152. doi:https://doi.org/10.1159/000443165 CrossRefPubMed

12.

Gonzalez-Flores E, Serrano R, Sevilla I, Viudez A, Barriuso J, Benavent M, Capdevila J, Jimenez-Fonseca P, Lopez C, Garcia-Carbonero R (2018) SEOM clinical guidelines for the diagnosis and treatment of gastroenteropancreatic and bronchial neuroendocrine neoplasms (NENs) (2018). Clin Transl Oncol 21:55–63. https://doi.org/10.1007/s12094-018-1980-7 CrossRefPubMedPubMedCentral

13.

Cienfuegos JA, Salguero J, Nunez-Cordoba JM, Ruiz-Canela M, Benito A, Ocana S, Zozaya G, Marti-Cruchaga P, Pardo F, Hernandez-Lizoain JL, Rotellar F (2017) Short- and long-term outcomes of laparoscopic organ-sparing resection in pancreatic neuroendocrine tumors: a single-center experience. Surg Endosc 31(10):3847–3857. https://doi.org/10.1007/s00464-016-5411-y CrossRefPubMed

14.

Inchauste SM, Lanier BJ, Libutti SK, Phan GQ, Nilubol N, Steinberg SM, Kebebew E, Hughes MS (2012) Rate of clinically significant postoperative pancreatic fistula in pancreatic neuroendocrine tumors. World J Surg 36(7):1517–1526. https://doi.org/10.1007/s00268-012-1598-9 CrossRefPubMedPubMedCentral

15.

Gaujoux S, Gonen M, Tang L, Klimstra D, Brennan MF, D’Angelica M, Dematteo R, Allen PJ, Jarnagin W, Fong Y (2012) Synchronous resection of primary and liver metastases for neuroendocrine tumors. Ann Surg Oncol 19(13):4270–4277. https://doi.org/10.1245/s10434-012-2462-8 CrossRefPubMed

16.

Han SL, Cheng J, Zhou HZ, Guo SC, Jia ZR, Wang PF (2010) Surgically treated primary malignant tumor of small bowel: a clinical analysis. World J Gastroenterol 16(12):1527–1532CrossRefPubMedPubMedCentral

17.

Norlen O, Stalberg P, Oberg K, Eriksson J, Hedberg J, Hessman O, Janson ET, Hellman P, Akerstrom G (2012) Long-term results of surgery for small intestinal neuroendocrine tumors at a tertiary referral center. World J Surg 36(6):1419–1431. https://doi.org/10.1007/s00268-011-1296-z CrossRefPubMed

18.

Jilesen AP, van Eijck CH, in’t Hof KH, van Dieren S, Gouma DJ, van Dijkum EJ (2016) Postoperative complications, in-hospital mortality and 5-year survival after surgical resection for patients with a pancreatic neuroendocrine tumor: a systematic review. World J Surg 40(3):729–748. https://doi.org/10.1007/s00268-015-3328-6 CrossRefPubMed

19.

DeOliveira ML, Winter JM, Schafer M, Cunningham SC, Cameron JL, Yeo CJ, Clavien PA (2006) Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 244(6):931–937; discussion 937-939. https://doi.org/10.1097/01.sla.0000246856.03918.9a CrossRefPubMedPubMedCentral

20.

Rindi G, Kloppel G, Couvelard A, Komminoth P, Korner M, Lopes JM, McNicol AM, Nilsson O, Perren A, Scarpa A, Scoazec JY, Wiedenmann B (2007) TNM staging of midgut and hindgut (neuro) endocrine tumors: a consensus proposal including a grading system. Virchows Arch 451(4):757–762. https://doi.org/10.1007/s00428-007-0452-1 CrossRefPubMed

21.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral

22.

Delle Fave G, O’Toole D, Sundin A, Taal B, Ferolla P, Ramage JK, Ferone D, Ito T, Weber W, Zheng-Pei Z, De Herder WW, Pascher A, Ruszniewski P, Vienna Consensus Conference p (2016) ENETS consensus guidelines update for gastroduodenal neuroendocrine neoplasms. Neuroendocrinology 103(2):119–124. https://doi.org/10.1159/000443168 CrossRefPubMed

23.

Ramage JK, De Herder WW, Delle Fave G, Ferolla P, Ferone D, Ito T, Ruszniewski P, Sundin A, Weber W, Zheng-Pei Z, Taal B, Pascher A, Vienna Consensus Conference p (2016) ENETS consensus guidelines update for colorectal neuroendocrine neoplasms. Neuroendocrinology 103 (2):139–143. doi:https://doi.org/10.1159/000443166 CrossRefPubMed

24.

Valente R, Lykoudis P, Tamburrino D, Inama M, Passas I, Toumpanakis C, Luong TV, Davidson B, Imber C, Malago M, Rahman SH, Shankar A, Sharma D, Caplin M, Fusai G (2017) Major postoperative complications after pancreatic resection for P-NETS are not associated to earlier recurrence. Eur J Surg Oncol 43(11):2119–2128. https://doi.org/10.1016/j.ejso.2017.07.012 CrossRefPubMed

25.

Jilesen AP, van Eijck CH, Busch OR, van Gulik TM, Gouma DJ, van Dijkum EJ (2016) Postoperative outcomes of enucleation and standard resections in patients with a pancreatic neuroendocrine tumor. World J Surg 40(3):715–728. https://doi.org/10.1007/s00268-015-3341-9 CrossRefPubMed

26.

Milanetto AC, Pasquali C, Da Broi M, Brambilla T, Capretti G, Zerbi A (2018) Ampullary neuroendocrine neoplasms: surgical experience of a rare and challenging entity. Langenbeck's Arch Surg 403(5):581–589. https://doi.org/10.1007/s00423-018-1695-9 CrossRef

27.

Alfieri S, Butturini G, Boggi U, Pietrabissa A, Morelli L, Vistoli F, Damoli I, Peri A, Fiorillo C, Pugliese L, Ramera M, De Lio N, Di Franco G, Esposito A, Landoni L, Rosa F, Menghi R, Doglietto GB, Quero G, Italian Robotic p NETG (2019) Short-term and long-term outcomes after robot-assisted versus laparoscopic distal pancreatectomy for pancreatic neuroendocrine tumors (pNETs): a multicenter comparative study. Langenbeck's Arch Surg 404(4):459–468. https://doi.org/10.1007/s00423-019-01786-x CrossRef

28.

Najafi N, Mintziras I, Wiese D, Albers MB, Maurer E, Bartsch DK (2020) A retrospective comparison of robotic versus laparoscopic distal resection and enucleation for potentially benign pancreatic neoplasms. Surg Today:1–9. https://doi.org/10.1007/s00595-020-01966-z

29.

Soreide JA, van Heerden JA, Thompson GB, Schleck C, Ilstrup DM, Churchward M (2000) Gastrointestinal carcinoid tumors: long-term prognosis for surgically treated patients. World J Surg 24(11):1431–1436CrossRefPubMed

30.

Woltering EA, Voros BA, Beyer DT, Wang YZ, Thiagarajan R, Ryan P, Wright A, Ramirez RA, Ricks MJ, Boudreaux JP (2017) Aggressive surgical approach to the management of neuroendocrine tumors: a report of 1,000 surgical cytoreductions by a single institution. J Am Coll Surg 224(4):434–447. https://doi.org/10.1016/j.jamcollsurg.2016.12.032 CrossRefPubMed

31.

Bosma E, Pullens MJ, de Vries J, Roukema JA (2016) The impact of complications on quality of life following colorectal surgery: a prospective cohort study to evaluate the Clavien-Dindo classification system. Color Dis 18(6):594–602. https://doi.org/10.1111/codi.13244 CrossRef

32.

Longo WE, Virgo KS, Johnson FE, Oprian CA, Vernava AM, Wade TP, Phelan MA, Henderson WG, Daley J, Khuri SF (2000) Risk factors for morbidity and mortality after colectomy for colon cancer. Dis Colon Rectum 43(1):83–91CrossRefPubMed

33.

Kirchhoff P, Clavien PA, Hahnloser D (2010) Complications in colorectal surgery: risk factors and preventive strategies. Patient Saf Surg 4(1):5. https://doi.org/10.1186/1754-9493-4-5 CrossRefPubMedPubMedCentral

34.

Gimm O, Barczynski M, Mihai R, Raffaelli M (2019) Training in endocrine surgery. Langenbeck's Arch Surg 404(8):929–944. https://doi.org/10.1007/s00423-019-01828-4 CrossRef

Title: Complications of surgery for gastro-entero-pancreatic neuroendocrine neoplasias
Authors: Max B. Albers
Martin Almquist
Anders Bergenfelz
Erik Nordenström
Publication date: 01-03-2020
Publisher: Springer Berlin Heidelberg
Keyword: Metastasis
Published in: Langenbeck's Archives of Surgery / Issue 2/2020
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-020-01869-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Complications of surgery for gastro-entero-pancreatic neuroendocrine neoplasias

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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