Hepato-pancreato-biliary
Neha Shafique, MD
Resident
Hospital of the University of Pennsylvania, United States
Neha Shafique, MD
Resident
Hospital of the University of Pennsylvania, United States
Neha Shafique, MD
Resident
Hospital of the University of Pennsylvania, United States
Nicholas Kelly, BA
Medical Student
University of Pennsylvania, United States
Gabriella N. Tortorello, MD
Resident
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States
Charles Vollmer, MD
Chief, Division of Gastrointestinal Surgery at Penn Medicine
Hospital of University of Pennsylvania, United States
Giorgos Karakousis, MD
Surgical oncologist
Hospital of the University of Pennsylvania, United States
Pancreatic neuroendocrine tumors (pNET) are rare neoplasms with a rising incidence in the United States. The recommended treatment for small (≤2cm) non-functional pNETs remains variable even in consensus guidelines. We sought to identify practice pattern trends in surgical resection of small pNETs, hypothesizing that as surgical morbidity and mortality of pancreatic surgery has improved, selection of patients with otherwise low risk neoplasms may be changing over time.
Methods:
The National Cancer Database (NCDB) was used to identify patients that underwent surgical resection for localized pNETs over the last decade between 2010 and 2019. Patients with clinically positive nodes or unknown nodal status, along with Stage 4 or unknown stage disease were excluded. Joinpoint regression was used to calculate annual percent changes (APCs) in the proportion of resected tumors that were less than 2 cm, along with changes in patient clinical factors.
Results:
In all, 11,170 patients met inclusion criteria. The median age was 61 (interquartile 51 – 69), 52.1% were male, and the majority (81.7%) were White. Median tumor size in overall cohort was 22 mm. The most common procedure in the cohort was distal pancreatectomy (5828; 52.2%), followed by pancreaticoduodenectomy (3,550, 31.8%).
In this cohort, 5,030 patients had ≤2cm tumors and the median size for that subset was 14mm. Over the study period, the percentage of resected tumors that were ≤2cm remained stable (42.2 vs 40.6%, APC 0.2, 95% CI -1.4 – 1.8). Compared to patients in 2010 undergoing resection for small pNETs, patients in 2019 were more likely to be older and more comorbid. The proportion of patients ≥ 65 years old steadily increased (45.2 vs 34.7%, APC 2.6, 95% CI 1.9 – 3.4), as did patients with a Charlson Deyo score of ≥ 2 (11.9 vs 5.7%, APC 8.5 95% CI 6.3 – 10.7). (Figure 1).
Conclusions:
Small pNETs represent around 45% of resected non-functioning pNETs with that proportion remaining stable over time. The age and Charlson comorbidity index of patients with resected small pNETS show an increase over time. Continued efforts should be made to optimize the selection of these patients, carefully weighing the malignant potential of these low risk tumors versus the morbidity of the surgical procedure.