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Indications for resection and perioperative outcomes of surgery for pancreatic neuroendocrine neoplasms in Germany: an analysis of the prospective DGAV StuDoQ|Pancreas registry

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Abstract

Purpose

Pancreatic neuroendocrine neoplasms (pNENs) are rare, and their surgical management is complex. This study evaluated the current practice of pNEN surgery across Germany, including its adherence with guidelines and its perioperative outcomes.

Methods

Patients who underwent surgery for pNENs (April 2013–June 2017) were retrieved from the prospective StuDoQ|Pancreas registry of the German Society of General and Visceral Surgery and retrospectively analyzed.

Results

A total of 287 patients (53.7% male) with a mean age of 59.2 ± 14.2 years old underwent pancreatic resection for pNENs. Tumors were localized in the pancreatic head (40.4%), body (23%), or tail (36.6%). A total of 239 (83.3%) patients underwent formal resection with lymphadenectomy, 40 (14%) parenchyma-sparing resection, and 8 (2.8%) only exploration. Fifty (17.4%) patients underwent a minimally invasive approach. Among the 245 patients with complete pathological information, 42 (17.1%) had distant metastases, 78 (31.8%) had stage I tumors, 74 (30.2%) stage II, and 51 (20.8%) stage III. A total of 112 (45.7%) patients had G1 tumors, 101 (41.2%) G2, and 24 (9.8%) G3. Nodal involvement on imaging was an independent predictor of lymph node metastasis according to the multivariable analysis (odds ratio: 0.057; 95% confidence interval: 0.016–0.209; p < 0.01). R0 resection was reported in 240 (83.6%) patients. The 30- and 90-day mortality rates were 2.8% and 4.2%, respectively.

Conclusion

In Germany the rate of potential curative resection for pNEN is high. However, formal pancreatic resection seems to be overrepresented, while minimally invasive resection is underrepresented.

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Acknowledgements

This study was conducted using the StuDoQ|Pancreas registry provided by the Study, Documentation, and Quality Center (Studien, Dokumentations- und Qualitätszentrum, StuDoQ) of the German Society for General and Visceral Surgery (Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, DGAV) with the ID StuDoQ-2017-0003. We would like to thank the following colleagues who actively participated in the StuDoQ|Pancreas registry and enrolled patients with pNENs: StuDoQ|Pancreas study group of the German Society for General and Visceral Surgery (DGAV): Prof. Dr. Michael Ghadimi, Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Göttingen, Germany. Prof. Dr. Stefan Post, PD Dr. Torsten J. Wilhelm, Chirurgische Klinik, Universitätsmedizin Mannheim, Mannheim, Germany. Prof. Dr. Christoph-Thomas Germer, Klinik & Poliklinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinik Würzburg, Würzburg, Germany. Prof. Dr. Waldemar Uhl, PD Dr. med. Orlin Belyaev, Klinik für Allgemein- und Viszeralchirurgie, St. Josef-Hospital, Bochum, Germany. Prof. Dr. Thomas Kraus, Allgemeine, Viszeral und Minimalinvasive Chirurgie, Nordwestkrankenhaus Frankfurt, Frankfurt, Germany. Prof. Dr. Helmut Witzigmann, Allgemein- und Viszeralchirurgie, Städtisches Klinikum Dresden Friedrichstadt, Dresden, Germany. Prof. Dr. Merten Hommann, Zentralklinik Bad Berka, Bad Berka, Germany. Prof. Dr. Ernst Klar, Allgemeine-, Thorax-, Gefäß- und Transplantationschirurgie, Universitätsmedizin Rostock, Rostock, Germany. Prof. Dr. Matthias Glanemann, Klinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Homburg an der Saar, Germany. Prof. Dr. Carsten Gutt, Allgemein-, Visceral-, Gefäß- und Thoraxchirurgie, Klinikum Memmingen, Memmingen, Germany. Prof. Dr. Thomas Manger, Abteilung für Allgemeine-, Viszeral- und Kinderchirurgie, SRH Waldklinikum Gera, Gera, Germany. Prof. Dr. Hans-Jörg Krämling, Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, EvK Düsseldorf, Düsseldorf, Germany. Prof. Dr. Jörg C. Kalff, PD Dr. Tim R. Glowka, Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Bonn, Germany. Prof. Dr. Natascha C. Nüssler, Klinik für Allgemein- und Viszeralchirurgie, Endokrine Chirurgie und Coloproktologie, Städt. Klinikum München GmbH, Klinikum Neuperlach, München, Germany. Prof. Dr. Jörg-Peter Ritz, Klinik für Allgemein- und Viszeralchirurgie, Helios Kliniken Schwerin, Schwerin, Germany. Prof. Dr. Winfried Padberg, Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen Marburg Standort Gießen, Giessen, Germany. Prof. Dr. Anton J. Kroesen, Klinik für Allgemein-, Viszeral- und Unfallchirurgie, Krankenhaus Porz am Rhein, Köln, Germany. Prof. Dr. Albrecht Stier, Klinik für Allgemein- und Viszeralchirurgie, Helios-Klinik Erfurt, Erfurt, Germany. Prof. Dr. Dietmar Lorenz, Chirurgische Klinik I, Sana Klinikum Offenbach, Offenbach, Germany. Prof. Dr. Wolf Otto Bechstein, Kllinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Frankfurt, Frankfurt, Germany. Prof. Dr. Karl-Jürgen Oldhafer, Allgemein- und Viszeralchirurgie, Asklepios Klinik Barmbek, Hamburg, Germany. PD Dr. Sven Eisold, Klinik für Allgemein- und Viszeralchirurgie, Sana Kliniken Lübeck GmbH, Lübeck, Germany. Dr. med. Ute Tröbs, Allgemein- und Viszeralchirurgie, Kreiskrankenhaus Delitzsch, Delitzsch, Germany. Prof. Dr. Hans-Bernd Reith, Allgemein- und Viszeralchirurgie, Agaplesion Diakoniekliniken Kassel, Kassel, Germany. Dr.med. Franz-Josef Schumacher, Klinik für Allgemein- und Viszeralchirurgie, Katholische Kliniken Oberhausen, Oberhausen, Germany. Prof. Dr. Elke Wagler, Allgemein-, Visceral- und Onkochirurgie, Pleißental-Klinik GmbH, Werdau, Germany. Prof. Dr. Stefan Farkas, Klinik für Allgemein- und Visceralchirurgie, Wiesbaden, Germany. Dr. med. Frank Klammer, Allgemein-, Viszeral- und Thoraxchirurgie, St. Franziskus-Hospital, Ahlen, Germany. Prof. Dr. Matthias Schwarzbach, Klinik für Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie, Klinikum Frankfurt-Höchst, Frankfurt, Germany. Prof. Dr. Marco Niedergethmann, Klinik für Allgemein- und Viszeralchirurgie, Alfried-Krupp-Krankenhaus, Essen, Germany. Prof. Dr. Norbert Runkel, Allgemein-, Viszeral- und Kinderchirurgie, Schwarzwald-Baar-Klinikum, Villingen-Schwenningen, Germany. Prof. Dr. Pompiliu Piso, Chirurgie I, Barmherzige Brüder Regensburg, Regensburg, Germany. Dr. med. Eric P. M. Lorenz, Viszeralchirurgie, Alexianer KH Hedwigshöhe, Berlin, Germany. PD Dr. Christian Mönch, Dr. Steffanie Bieck, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Westpfalz-Klinikum Kaiserslautern, Kaiserslautern, Germany. Prof. Dr. Robert Grützmann, Dr. Max Brunner, Chirurgische Klinik, Universitätsklinikum Erlangen, Erlangen, Germany. Prof. Dr. Helmut Friess, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, TUM, München, Germany.

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Authors and Affiliations

  1. Department of Visceral-, Thoracic- and Vascular Surgery, Philipps-University Marburg, Baldingerstrasse, 35043, Marburg, Germany

    Ioannis Mintziras & Detlef Klaus Bartsch

  2. Clinic for Surgery, University Clinic Schleswig-Holstein, UKSH Campus Lübeck, Lübeck, Germany

    Tobias Keck

  3. Department of General, Visceral, Vascular and Transplant Surgery, Klinikum Der Universität München, Munich, Germany

    Jens Werner

  4. Department of General and Visceral Surgery, University Clinic Freiburg, Freiburg, Germany

    Stefan Fichtner-Feigl & Uwe Wittel

  5. Department of General and Visceral Surgery, University Clinic Münster, Münster, Germany

    Norbert Senninger & Thorsten Vowinkel

  6. Department of General and Visceral Surgery, Klinikum Oldenburg, Oldenburg, Germany

    Norbert Senninger

  7. Department of General-, Visceral- and Vascular Surgery, St. Josefskrankenhaus, Freiburg, Germany

    Thorsten Vowinkel

  8. Department of General, Visceral, Thoracic and Transplant Surgery, Katharinenhospital, Stuttgart, Germany

    Jörg Köninger

  9. Department of General, Visceral and Transplant Surgery, Klinikum Augsburg, Augsburg, Germany

    Matthias Anthuber & Bernd Geißler

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  1. Ioannis Mintziras
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For the StuDoQ|Pancreas Study Group of the German Society for General, Visceral Surgery (DGAV)

  • Michael Ghadimi
  • , Stefan Post
  • , Torsten J. Wilhelm
  • , Christoph-Thomas Germer
  • , Waldemar Uhl
  • , Orlin Belyaev
  • , Thomas Kraus
  • , Helmut Witzigmann
  • , Merten Hommann
  • , Ernst Klar
  • , Matthias Glanemann
  • , Carsten Gutt
  • , Thomas Manger
  • , Hans-Jörg Krämling
  • , Jörg C. Kalff
  • , Natascha C. Nüssler
  • , Jörg-Peter Ritz
  • , Winfried Padberg
  • , Anton J. Kroesen
  • , Albrecht Stier
  • , Dietmar Lorenz
  • , Wolf Otto Bechstein
  • , Karl-Jürgen Oldhafer
  • , Sven Eisold
  • , Ute Tröbs
  • , Hans-Bernd Reith
  • , Franz-Josef Schumacher
  • , Elke Wagler
  • , Stefan Farkas
  • , Frank Klammer
  • , Matthias Schwarzbach
  • , Marco Niedergethmann
  • , Norbert Runkel
  • , Pompiliu Piso
  • , Eric P. M. Lorenz
  • , Christian Mönch
  • , Steffanie Bieck
  • , Robert Grützmann
  • , Max Brunner
  •  & Helmut Friess

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Correspondence to Ioannis Mintziras.

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The members of For the StuDoQ|Pancreas study group of the German Society for General and Visceral Surgery (DGAV) are listed in Acknowledgements.

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Mintziras, I., Keck, T., Werner, J. et al. Indications for resection and perioperative outcomes of surgery for pancreatic neuroendocrine neoplasms in Germany: an analysis of the prospective DGAV StuDoQ|Pancreas registry. Surg Today 49, 1013–1021 (2019). https://doi.org/10.1007/s00595-019-01838-1

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