Sporadic nonfunctional pancreatic neuroendocrine tumors: Risk of lymph node metastases and aggressiveness according to tumor size: A multicenter international study

Julie Perinel, Gennaro Nappo, Alessandro Zerbi, Charlotte M. Heidsma, Elisabeth J.M. Nieveen van Dijkum, Ho Seong Han, Yoo Seok Yoon, Sohei Satoi, Ihsan Ekin Demir, Helmut Friess, Yogesh Vashist, Jakob Izbicki, Alexandra Charlotte Muller, Beat Gloor, Marta Sandini, Luca Gianotti, Fabien Subtil, Mustapha Adham

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Background: Although the correlation between tumor size and aggressiveness is clearly established in sporadic nonfunctional pancreatic neuroendocrine tumors, the management of tumors ≤2 cm remains debated. In recent guidelines, the cut-off size to operate ranged from 1 to 2 cm. The aim of this retrospective study was to report the rate of lymph nodes metastases in resected sporadic nonfunctional pancreatic neuroendocrine tumors, according to tumor size and, second, to identify risk factors of lymph node metastases and disease-free survival. Methods: Resected sporadic nonfunctional pancreatic neuroendocrine tumors from 9 international expert centers were included (1999–2017). Functional pancreatic neuroendocrine tumors, genetic syndromes, and R2 resection were excluded. Aggressiveness was defined as microvascular invasion, perineural invasion, lymph node metastases, G3 grading, distant metastases, and/or recurrence. Results: Overall, 495 resected sporadic nonfunctional pancreatic neuroendocrine tumors were included. For tumors up to 5 cm, the risk of lymph node metastases was increased by 1.73 for every 1 cm increase in size (odds ratio = 1.73; 95% confidence interval = 1.46–2.03). Tumor size >2 cm (P < .001), perineural invasion (P = .002), microvascular invasion (P < .001), and distant metastases (P = .008) were independently associated with lymph node metastases. Tumor size >2 cm (P = .003), R1 status (P = .004), lymph node metastases (P < .001), and World Health Organization grade 3 (P = .002) were independently associated with disease-free survival. Aggressiveness rate was 13.1% in tumors ≤1 cm and 29% in tumors between 1.1 and 2 cm. Conclusion: In resected sporadic nonfunctional pancreatic neuroendocrine tumors, the risk of lymph node metastases is correlated to tumor size. Considering that sporadic nonfunctional pancreatic neuroendocrine tumors between 1.1 and 2 cm had a higher risk of lymph node metastases and recurrence compared to tumors ≤1 cm, the decision to perform surgery in this subgroup of patients should be individualized in surgically fit patients.

Original languageEnglish
Pages (from-to)975-981
Number of pages7
JournalSurgery
Volume172
Issue number3
DOIs
StatePublished - Sep 2022
Externally publishedYes

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