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Begum N, Maasberg S, Pascher A, Plöckinger U, Gress TM, Wurst C, Weber F, Raffel A, Krausch M, Holzer K, Bartsch DK, Musholt TJ, Keck T, Anlauf M, Rinke A, Pape UF, Goretzki PE. Long-term outcome of surgical resection in patients with gastroenteropancreatic neuroendocrine neoplasia: results from a German nation-wide multi-centric registry. Langenbecks Arch Surg 2020; 405:145-154. [PMID: 32372309 DOI: 10.1007/s00423-020-01868-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/22/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Neuroendocrine neoplasia (NEN) are rare and heterogenous tumours. Few data exist on the impact of surgical therapy. MATERIALS AND METHODS This is a retrospective analysis of prospectively collected data of gastroenteropancreatic NEN in the German NET-Registry (1999-2012). It focuses on patients without distant metastases (limited disease, LD, stage I-IIIB). RESULTS Data of 2239 patients with NEN were recorded. Median age was 59 years, the gender ratio was 1:1.3 (f:m). A total of 986 patients (44%) had LD, and the 5-year survival rate (5 years) was 77% for all and 90% for patients with LD. A total of 1635 patients (73%) received a surgical therapy (1st to 6th line); the 5 and 10 ysr were 83/65% after and 59/35% without surgery for all patients (p < .001). The resection margins in the LD patients were 76%, 16%, and 3% for R0, R1 and R2, respectively. The 10 ysr was 84%, 59% and 42% for R0, R1 and R2 resections, respectively (p = .021 R0/R1, p < .001 R0/R2). The R0 resection rate was 75% for G1/G2 NET and 67% for G3 NEC. CONCLUSION The rate of complete tumour resection (R0) in LD is independent of tumour grading, and R0 resection is the key determinant of long-term survival, as demonstrated by the 10 ysr. of 84%. All NEN patients with limited disease should be considered for operation, if possible, as the best 10-year survival is shown after an R0 resection.
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Affiliation(s)
- Nehara Begum
- Department for General-, Visceral- and Minimalinvasive Surgery, Agaplesion Evangelisches Klinikum Schaumburg, Obernkirchen, Germany.
| | - Sebastian Maasberg
- Department for Internal Medicine and Gastroenterology, Asklepios Hospital St. Georg, Lohmühlenstrasse 5, Hamburg, Germany.,Department of Hepatology and Gastroenterology, Campus Virchow Clinic, Charite, University Medicine Berlin, Berlin, Germany
| | - Andreas Pascher
- Department General-, Visceral- and Transplant Surgery, University Hospital Münster, Münster, Germany
| | - Ursula Plöckinger
- Centre of Metabollism: Endocrinology, Diabetes and Metabolism, Campus Virchow Clinic, Charite University-Medicine Berlin, Berlin, Germany
| | - Thomas M Gress
- Department of Gastroenterology and Endocrinology, University Hospital Marburg (UKGM), Marburg, Germany
| | - Christine Wurst
- Department of Surgery, Klinikum Crailsheim, Crailsheim, Germany
| | - Frank Weber
- Department of General-, Visceral- and Transplantation Surgery, Division of Endocrine Surgery, Medical Faculty, University Duisburg-Essen, Duisburg, Germany
| | - Andreas Raffel
- Department for General-, Visceral- and Endocrine Surgery, Marienhospital Gelsenkirchen, Gelsenkirchen, Germany
| | - Markus Krausch
- Department for General-, Visceral- and Endocrine Surgery, Marienhospital Gelsenkirchen, Gelsenkirchen, Germany
| | - Katharina Holzer
- Department of Visceral-, Thoracic- and Vascular Surgery, Section of Endocrine Surgery, University Hospital Marburg (UKGM), Marburg, Germany
| | - Detlef K Bartsch
- Department of Visceral-, Thoracic- and Vascular Surgery, University Hospital Marburg (UKGM), Marburg, Germany
| | - Thomas J Musholt
- Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University Medicine Mainz, Mainz, Germany
| | - Tobias Keck
- Department of General Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany
| | | | - Anja Rinke
- Department of Gastroenterology and Endocrinology, University Hospital Marburg (UKGM), Marburg, Germany
| | - Ulrich-Frank Pape
- Department for Internal Medicine and Gastroenterology, Asklepios Hospital St. Georg, Lohmühlenstrasse 5, Hamburg, Germany.,Department of Hepatology and Gastroenterology, Campus Virchow Clinic, Charite, University Medicine Berlin, Berlin, Germany
| | - Peter E Goretzki
- Department of General, Visceral and Transplant Surgery, Section of Endocrine Surgery, Charite, University Medicine Berlin, Berlin, Germany
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