Radical intended surgery for highly selected stage IV neuroendocrine neoplasms G3

Elettra Merola; Massimo Falconi; Anja Rinke; Stefan Staettner; Felix Krendl; Stefano Partelli; Valentina Andreasi; Thomas M Gress; Andreas Pascher; Ruza Arsenic; Claudio Doglioni; Daniel Kaemmerer; Bertram Wiedenmann; Marianne E Pavel

doi:10.1016/j.amjsurg.2020.03.009

Radical intended surgery for highly selected stage IV neuroendocrine neoplasms G3

Am J Surg. 2020 Aug;220(2):284-289. doi: 10.1016/j.amjsurg.2020.03.009. Epub 2020 Mar 14.

Authors

Affiliations

¹ Department of Medicine 1, Division of Endocrinology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Department of Gastroenterology, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy. Electronic address: [email protected].
² Pancreatic Surgery Unit, Vita-Salute University, San Raffaele Hospital IRCCS, Milan, Italy.
³ Department of Gastroenterology, Endocrinology, Metabolism and Infectiology, University Hospital Marburg and Philipps University, Marburg, Germany.
⁴ Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria.
⁵ Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Münster, Münster, Germany; Department of Surgery, Charité Universitätsmedizin, Berlin, Germany.
⁶ Department of Pathology, Charité Mitte, Charité Universitätsmedizin, Berlin, Germany.
⁷ Pathology Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
⁸ Department of General and Visceral Surgery, Zentralklinik Bad Berka, Bad Berka, Germany.
⁹ Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Campus Mitte, Charité Universitätsmedizin, Berlin, Germany.
¹⁰ Department of Medicine 1, Division of Endocrinology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Campus Mitte, Charité Universitätsmedizin, Berlin, Germany.

PMID: 32209239
DOI: 10.1016/j.amjsurg.2020.03.009

Abstract

Background: Stage IV gastro-entero-pancreatic neuroendocrine neoplasms (GEP-NENs) G3 are the NENs with the worst prognosis. According to ENETS guidelines, platinum-based chemotherapy is the standard treatment for this population. Surgery is only considered in highly selected "resectable" NENs with usually lower Ki67. However, the role of surgery with curative intent has been poorly investigated.

Objective: To describe, in a retrospective series of stage IV GEP-NENs G3, overall survival (OS) and recurrence-free survival (RFS) rates after curatively intended surgery.

Methods: Multicenter analysis of stage IV GEP-NENs G3 receiving radical resection (R0/R1) from 2007 to 2017, with minimum post-surgical follow-up time of 3 months.

Results: Fifteen patients from 6 NEN referral centers, with median follow-up of 29 months (8-86), were included. Eight cases had a neuroendocrine carcinoma (NEC) and 7 a neuroendocrine tumor G3 (NET G3). Median OS after radical surgery was 59 months. All patients recurred, with a median RFS of 8 months.

Conclusions: Radical surgery might be considered for highly selected stage IV GEP-NENs G3. Larger series are needed to confirm these results.

Keywords: Neuroendocrine neoplasms G3; Overall survival; Recurrence; Stage IV; Surgery.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Female
Humans
Male
Middle Aged
Neoplasm Grading
Neoplasm Recurrence, Local
Neoplasm Staging
Neuroendocrine Tumors / mortality
Neuroendocrine Tumors / pathology
Neuroendocrine Tumors / surgery*
Patient Selection*
Retrospective Studies
Survival Rate