Detailed Abstract
[E-poster - Biliary & Pancreas (Biliary Disease/Surgery)]
[EP 164] Optimal Surgical Management of Unifocal Vs. Multifocal NF-PNETs: a Respective Cohort Study
Juwan KIM 1, Seung Soo HONG 2, Sung Hyun KIM 2, Ho Kyong HWANG 2, Chang Moo KANG 2
1 Department of Surgery , Severance Hospital, REPUBLIC OF KOREA, 2 Division of Hepatobiliary And Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea , Severance Hospital, REPUBLIC OF KOREA
Background : Pancreatic neuroendocrine tumors (PNETs) represent 1–2% of pancreatic tumors, with recent guidelines recommending active surveillance for non-functioning PNETs (NF-PNETs) smaller than 2 cm. However, the management of multiple NF-PNETs, as well as the influence of tumor number on prognosis, remains under-researched.
Methods : This retrospective study analyzed NF-PNET patients who underwent surgery at Severance Hospital between February 1993 and August 2023, comparing the characteristics of patients diagnosed with multifocal tumors and those with unifocal tumors.
Results : Of 187 patients, 169 (90.4%) had unifocal and 18 (9.6%) had multifocal tumors. Multifocal tumors were more likely to be diffusely spread, necessitating more total pancreatectomies (diffuse tumor location: 4.7% in unifocal vs 38.9% in multifocal cases, p<0.001; total pancreatectomy: 4.1% in unifocal vs 33.3% in multifocal cases, p<0.001). In patients with NF-PNET who underwent the same extent of pancreatic resection, no significant difference in the incidence of complication was observed regardless of multifocality. Moreover, no significant difference in OS was seen between the unifocal and multifocal groups (log-rank test: p=0.93). However, the multifocal group exhibited a poorer prognosis in terms of RFS compared to the unifocal group (log-rank test: p=0.004) Hereditary syndrome, tumor grade, size, lymphovascular invasion, and lymph node metastasis were key factors in the recurrence.
Conclusions : This study has revealed that multiple tumors after surgery are associated with decreased reecurrence-free survival but do not impact long-term survival. Therefore, considering the risks and impact on quality of life of extensive surgeries, a more conservative 'watch and wait' approach may be preferable in cases of multifocal tumors.
Methods : This retrospective study analyzed NF-PNET patients who underwent surgery at Severance Hospital between February 1993 and August 2023, comparing the characteristics of patients diagnosed with multifocal tumors and those with unifocal tumors.
Results : Of 187 patients, 169 (90.4%) had unifocal and 18 (9.6%) had multifocal tumors. Multifocal tumors were more likely to be diffusely spread, necessitating more total pancreatectomies (diffuse tumor location: 4.7% in unifocal vs 38.9% in multifocal cases, p<0.001; total pancreatectomy: 4.1% in unifocal vs 33.3% in multifocal cases, p<0.001). In patients with NF-PNET who underwent the same extent of pancreatic resection, no significant difference in the incidence of complication was observed regardless of multifocality. Moreover, no significant difference in OS was seen between the unifocal and multifocal groups (log-rank test: p=0.93). However, the multifocal group exhibited a poorer prognosis in terms of RFS compared to the unifocal group (log-rank test: p=0.004) Hereditary syndrome, tumor grade, size, lymphovascular invasion, and lymph node metastasis were key factors in the recurrence.
Conclusions : This study has revealed that multiple tumors after surgery are associated with decreased reecurrence-free survival but do not impact long-term survival. Therefore, considering the risks and impact on quality of life of extensive surgeries, a more conservative 'watch and wait' approach may be preferable in cases of multifocal tumors.
SESSION
E-poster
E-Session 03/21 ALL DAY