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Low morbidity, prolonged survival after surgery for patients with neuroendocrine tumors
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An “aggressive” surgical approach for most neuroendocrine tumors prolonged overall survival and resulted in low morbidity in most patients, according to findings from a retrospective survival analysis published in the Journal of the American College of Surgeons.
“Survival estimates for patients with [neuroendocrine tumors] vary widely in the literature, and disagreement exists among experts as to whether survival has improved in the last several decades,” Eugene A. Woltering, MD, FACS, of Louisiana State University Health Sciences Center in New Orleans, and colleagues wrote. “Despite advancements in the awareness, understanding and management of [neuroendocrine tumors], many have suggested that survival rates have remained relatively unchanged. ... We were prompted to undertake this study due to the conflicting survival results reported in the current literature, the shortage of large, single-institutional or multi-institutional studies including [neuroendocrine tumors] originating at all sites, and the discordance among physicians as to the optimal treatment strategy to increase survival.”
Woltering and colleagues analyzed medical records from 800 patients with histologically confirmed neuroendocrine tumors who underwent 1,001 surgical cytoreductions (mean age at diagnosis, 55 years; 73% treated with somatostatin analogue therapy). Patients were stratified by 10 primary tumors sites: lung, stomach, duodenum, pancreas, appendix, rectum, small bowel (small intestine, ileum, jejunum), colon, other site (kidney, ovary, adrenal gland) and unknown (primary site never discovered). Researchers assessed the complications and overall survival rates for patients at all stages of disease by primary tumor site.
Apart from somatostatin analogue therapy, 430 patients did not receive treatment before surgery, according to researchers. Within the cohort, 65% of patient tumors originated at the small bowel; 138 patients presented with an unknown primary site, which was localized intraoperatively in 89% of cases (complication rate, 9%; incidence of intraoperative carcinoid crisis, 1%.). Mean hospital stay for all patients was 9 days. Researchers observed minor postoperative complications after 43% of procedures; major postoperative complications occurred after 19% of procedures. The overall 30-day postoperative mortality rate was 2%.
During the study, 229 patients (29%) died. Mean overall survival for the cohort was 18.8 years; median actuarial survival for the cohort was 25 years; life expectancy difference after surgical cytoreduction for all patients was 11.2 years, according to researchers.
For pancreatic neuroendocrine tumors, median overall survival was 124 months; 5-, 10- and 20-year overall survival was 67%, 51% and 36%, respectively. The life expectancy difference (between overall survival and actuarial survival) after surgical cytoreduction for pancreatic neuroendocrine tumors was 16.6 years. The 5-, 10- and 20-year overall survival rates for the cohort were 82%, 65% and 37%, respectively.
Median overall survival for small bowel (neuroendocrine tumors) was 161 months; the 5-, 10- and 20-year overall survival rates were 84%, 67% and 31%, respectively. The life expectancy difference after surgical cytoreduction for small bowel (neuroendocrine tumors) was 11.7 years.
“Many researchers who have argued against utilizing an aggressive surgical approach suggest that there is minimal evidence to support aggressive management in patients with [neuroendocrine tumors],” the researchers wrote. “Based on the results of the current study, we believe that this argument no longer has merit.” – by Regina Schaffer
Disclosure: Woltering reports serving as a speaker and consultant for Inter Science Institute, Ipsen Biopharmaceuticals Inc. and Lexicon Pharmaceuticals Inc. Please see the full study for the other authors’ relevant financial disclosures.
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