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Amini N, Demyan L, Shah M, Standring O, Gazzara E, Lad N, Deperalta DK, Weiss M, Deutsch G. Decreasing utilization of surgical interventions amongst patients with pancreatic neuroendocrine tumor with liver metastases. Am J Surg 2024; 227:77-84. [PMID: 37798150 DOI: 10.1016/j.amjsurg.2023.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/31/2023] [Accepted: 09/25/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Since 2013, North American Neuroendocrine Tumor Society (NANETS) consensus-guidelines have endorsed consideration of surgical intervention for pancreatic- neuroendocrine tumors (PNET) with liver metastases. METHODS Patients with non-functional PNET with liver only metastases from 2010 to 2019 were identified from the National Cancer Database. RESULTS 34.7% underwent surgical intervention (13% PNET resection, 2.1% surgical management of liver metastases (SMLM), 19.5% PNET resection + SMLM). In multivariable analysis, government insurance, year of diagnosis>2013, increasing primary tumor size were associated with lower rate of surgical intervention. Receiving treatment at an academic center (OR 3.59, 95%CI 1.81-7.11; P < 0.001) or integrated cancer network (OR 3.21, 95%CI 1.57-6.54; P = 0.001) was associated with a higher rate of surgical intervention. The overall rate of surgical intervention decreased from 45.7% in 2010 to 23.0% in 2019. CONCLUSION Despite guideline recommendations and the suggested survival benefits, only one-third of patients underwent surgical intervention, potentially influenced by the rising utilization of systemic therapy in the past decade.
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Affiliation(s)
- Neda Amini
- Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr., Manhasset, NY, 11030, USA
| | - Lyudmyla Demyan
- Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr., Manhasset, NY, 11030, USA
| | - Manav Shah
- Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, 500 Hofstra Blvd Hempstead, NY, 11549, USA
| | - Oliver Standring
- Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr., Manhasset, NY, 11030, USA
| | - Emma Gazzara
- Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr., Manhasset, NY, 11030, USA
| | - Neha Lad
- Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr., Manhasset, NY, 11030, USA
| | - Danielle K Deperalta
- Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr., Manhasset, NY, 11030, USA; Northwell Health Cancer Institute, 1111 Marcus Avenue, Lake Success, NY, 11042, USA; Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, 500 Hofstra Blvd Hempstead, NY, 11549, USA
| | - Matthew Weiss
- Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr., Manhasset, NY, 11030, USA; Northwell Health Cancer Institute, 1111 Marcus Avenue, Lake Success, NY, 11042, USA; Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, 500 Hofstra Blvd Hempstead, NY, 11549, USA
| | - Gary Deutsch
- Northwell Health, North Shore/Long Island Jewish General Surgery, 300 Community Dr., Manhasset, NY, 11030, USA; Northwell Health Cancer Institute, 1111 Marcus Avenue, Lake Success, NY, 11042, USA; Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, 500 Hofstra Blvd Hempstead, NY, 11549, USA.
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