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Multimodality management, recurrence patterns, and long-term outcome of gastroenteropancreatic neuroendocrine neoplasms: Progress over 17 years

  • Gunjan S. DesaiEmail author
  • Prasad Pande
  • Verushka Chhabra
  • Rajiv C. Shah
  • Palepu Jagannath
Original Article
  • 7 Downloads

Abstract

Background

Many advances in the management of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) happened in the last two decades. This study highlights the progress in its management over 17 years, outcomes, recurrence patterns, and follow up protocols.

Methods

This retrospective analysis of prospectively maintained database at a single tertiary center included GEP-NEN patients from January 2001 to August 2017. Management protocols were based on European Neuroendocrine Tumor Society guidelines. Recurrences were categorized as follows: localized nodal, regional, distant hepatic, or combined. Patients were divided into cohorts: cohort 1 (2001–2006), cohort 2 (2007–2011), and cohort 3 (2012–2017). Survival patterns were analyzed.

Results

One hundred and ninety-two patients were included with 98 (51.04%) grade (G) 1, 64 (33.34%) G2, and 30 (15.63%) G3. One hundred and four (54.16%) underwent curative surgery (58 G1, 27 G2, and 19 G3). Overall follow up ranged from 3 to 276 months; 39 were lost to follow up. Ninety-six patients had recurrences: 44 regional + distant and 40 liver-limited recurrences. One-, 3-, and 5-year survivals show significant differences among different treatment groups (p < 0.05). Significant increase in curative resections, chemotherapy utilization, and reduced recurrences were noted in cohort 3. Curative (R0) resection offered 1- and 3-year overall survival of 93.3% and 66.7% in cohort 1; 95.8% and 83.1% in cohort 2; and 100% and 92.9% in cohort 3.

Conclusion

Curative resection is the most significant factor for improved survival. Debulking surgerical procedure have a role whereas upfront peptide receptor radionuclide therapy is questionable. Chemotherapy improves overall survival in inoperable/metastatic setting. Recurrence patterns indicate that a long-term follow up greater than 10 years is necessary.

Keywords

Liver metastasis Neuroendocrine neoplasms Recurrence patterns Survival analysis 

Notes

Compliance with ethical standards

Conflict of interest

GSD, PP, VC, RCS, and PJ declare that they have no conflict of interest.

Grants/other financial support

Financial support for this study was provided by an educational grant from the “Hepato-Pancreato-Biliary Training, Education and Research Foundation (HPB TERF).”

Ethics statement

The study was performed in a manner conforming to the Helsinki Declaration of 1975, as revised in 2000 and 2008, concerning human and animal rights, and the authors followed the policy concerning informed consent as shown in springer.com.

Disclaimer

The authors are solely responsible for the data and the content of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, or the printer/publishers are responsible for the results/findings and content of this article.

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Copyright information

© Indian Society of Gastroenterology 2019

Authors and Affiliations

  1. 1.Department of Gastrointestinal SurgeryLilavati Hospital and Research CenterMumbaiIndia
  2. 2.Department of Gastrointestinal SurgeryMPCT HospitalNavi MumbaiIndia
  3. 3.Department of General SurgeryPrime HospitalDubaiUAE
  4. 4.Department of Surgical OncologyLilavati Hospital and Research CentreMumbaiIndia

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