Association of a Palliative Surgical Approach to Stage IV Pancreatic Neuroendocrine Neoplasms with Survival: A Systematic Review and Meta-Analysis.

Marina Tsoli,Kosmas Daskalakis,Gregory Kaltsas,Maria-Eleni Spei,Göran Wallin

doi:10.3390/cancers12082246

Marina Tsoli, Kosmas Daskalakis + Show 3 more

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https://doi.org/10.3390/cancers12082246

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Abstract

The role of primary tumor resection in patients with pancreatic neuroendocrine neoplasms (PanNENs) and unresectable distant metastases remains controversial. We aimed to evaluate the effect of palliative primary tumor resection (PPTR) on overall survival (OS) in this setting. We searched the MEDLINE, Embase, Cochrane Library, Web of Science and SCOPUS databases up to January 2020 and used the Newcastle–Ottawa scale (NOS) criteria to assess quality/risk of bias. A total of 5661 articles were screened. In 10 studies, 5551 unique patients with stage IV PanNEN and unresectable metastases were included. The five-year OS for PanNEN patients undergoing PPTR in stage IV was 56.6% vs. 23.9% in the non-surgically treated patients (random effects relative risk (RR): 1.70; 95% CI: 1.53–1.89). Adjusted analysis of pooled hazard ratios (HR) confirmed longer OS in PanNEN patients undergoing PPTR (random effects HR: 2.67; 95% CI: 2.24–3.18). Cumulative OS analysis confirmed an attenuated survival benefit over time. The complication rate of PPTR was as high as 27%. In conclusion, PPTR may exert a survival benefit in stage IV PanNEN. However, the included studies were subject to selection bias, and special consideration should be given to PPTR anchored to a multimodal treatment strategy. Further longitudinal studies are warranted, with long-term follow-up addressing the survival outcomes associated with surgery in stage IV disease.

Highlights

Pancreatic neuroendocrine neoplasms (PanNENs) are increasingly recognized and have a diverse clinical course, along with a variable metastatic propensity related to their biological behavior, the extent of disease and secretory status [1]
There was no significant heterogeneity across the studies (I2 = 0%, p-value > 0.10)
We conducted a sensitivity analysis focusing on the impact of non-surgery in patients with stage IV PanNENs with regards to overall mortality

Summary

Introduction

Pancreatic neuroendocrine neoplasms (PanNENs) are increasingly recognized and have a diverse clinical course, along with a variable metastatic propensity related to their biological behavior, the extent of disease and secretory status [1]. This is important, as approximately 60% of patients with. In the majority of these patients, curative surgery is not feasible due to the pattern and extent of NEN metastases [3]. Cancers 2020, 12, 2246 tumoral size is generally recommended when curative R0 resection is feasible.

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