Radical intended surgery for highly selected stage IV neuroendocrine neoplasms G3 - 20/06/20

Doi : 10.1016/j.amjsurg.2020.03.009

Elettra Merola ^a,^b,^⁎ , Massimo Falconi ^c, Anja Rinke ^d, Stefan Staettner ^e, Felix Krendl ^e, Stefano Partelli ^c, Valentina Andreasi ^c, Thomas M. Gress ^d, Andreas Pascher ^f,^g, Ruza Arsenic ^h, Claudio Doglioni ⁱ, Daniel Kaemmerer ^l, Bertram Wiedenmann ^m, Marianne E. Pavel ^a,^m
^a Department of Medicine 1, Division of Endocrinology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
^b Department of Gastroenterology, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
^c Pancreatic Surgery Unit, Vita-Salute University, San Raffaele Hospital IRCCS, Milan, Italy
^d Department of Gastroenterology, Endocrinology, Metabolism and Infectiology, University Hospital Marburg and Philipps University, Marburg, Germany
^e Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
^f Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Münster, Münster, Germany
^g Department of Surgery, Charité Universitätsmedizin, Berlin, Germany
^h Department of Pathology, Charité Mitte, Charité Universitätsmedizin, Berlin, Germany
ⁱ Pathology Unit, Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
^l Department of General and Visceral Surgery, Zentralklinik Bad Berka, Bad Berka, Germany
^m Department of Hepatology and Gastroenterology, Campus Virchow-Klinikum and Campus Mitte, Charité Universitätsmedizin, Berlin, Germany

^∗Corresponding author. Department of Gastroenterology, Azienda Provinciale per i Servizi Sanitari (APSS) di Trento, Largo Medaglie D’Oro 9, 38122, Trento, Italy. Tel.: +390461 903954.Department of GastroenterologyAzienda Provinciale per i Servizi Sanitari (APSS) di TrentoLargo Medaglie D’Oro 9Trento38122Italy

Abstract

Background

Stage IV gastro-entero-pancreatic neuroendocrine neoplasms (GEP-NENs) G3 are the NENs with the worst prognosis. According to ENETS guidelines, platinum-based chemotherapy is the standard treatment for this population. Surgery is only considered in highly selected “resectable” NENs with usually lower Ki67. However, the role of surgery with curative intent has been poorly investigated.

Objective

To describe, in a retrospective series of stage IV GEP-NENs G3, overall survival (OS) and recurrence-free survival (RFS) rates after curatively intended surgery.

Methods

Multicenter analysis of stage IV GEP-NENs G3 receiving radical resection (R0/R1) from 2007 to 2017, with minimum post-surgical follow-up time of 3 months.

Results

Fifteen patients from 6 NEN referral centers, with median follow-up of 29 months (8-86), were included. Eight cases had a neuroendocrine carcinoma (NEC) and 7 a neuroendocrine tumor G3 (NET G3). Median OS after radical surgery was 59 months. All patients recurred, with a median RFS of 8 months.

Conclusions

Radical surgery might be considered for highly selected stage IV GEP-NENs G3. Larger series are needed to confirm these results.

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Highlights

•	Surgery with radical intent might be considered for selected stage IV GEP-NENs G3.
•	Median OS after radical surgery was 59 months in these patients.
•	All patients recurred, with a median RFS of 8 months.

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Keywords : Neuroendocrine neoplasms G3, Stage IV, Surgery, Overall survival, Recurrence