Exploring the surgical landscape of pancreatic neuroendocrine neoplasia in Austria: Results from the ASSO pNEN study group

Primavesi, Florian; Klieser, E.; Cardini, Benno; Marsoner, Katharina; Fröschl, Uwe; Thalhammer, Sabine; Fischer, Ines; Hauer, A.; Urbas, Romana; Kiesslich, Tobias; Neureiter, Daniel; Zitt, Matthias; Klug, R.; Wundsam, Helwig; Sellner, F.; Karner, J.; Függer, R.; Cakar-Beck, Fergül; Kornprat, Peter; Öfner, Dietmar; Stättner, Stefan

doi:10.1016/j.ejso.2018.08.016

Cited by 15 publications

(15 citation statements)

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“…In our study, mortality rate was 2.6%, clinically relevant post-operative pancreatic fistula (excluding total pancreatectomy) occurred only in 15% of cases, and 62% of patients had an uneventful post-operative course. These results are in line with a recent study on “high-risk complication” patients who underwent pancreatic surgery [ 22 ], with morbidity and mortality rates of 42.5% and 3.5%, respectively. Particularly, morbidity and mortality rates of patients who underwent major pancreatic surgery (total pancreatectomy and pancreatico-duodenectomy) was 40% and nil, respectively.…”

Section: Discussionsupporting

confidence: 91%

A Plea for Surgery in Pancreatic Metastases from Renal Cell Carcinoma: Indications and Outcome from a Multicenter Surgical Experience

Milanetto

Morelli

Franco

et al. 2020

JCM

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Background: Pancreatic metastases from renal-cell carcinoma (RCC-PMs) are rare. Surgery may play a role in improving overall (OS) and disease-free survival (DFS). Methods: Clinical-pathological features, surgery and follow-up data of patients with RCC-PMs operated on in three pancreatic surgical centers (2000–2019) were retrospectively evaluated. Results: Thirty-nine patients (21 male/18 female, averaging 65 years) were enrolled. RCC-PMs were metachronous in 36 patients (mean 94 months, up to 24 years after nephrectomy), multiple in 21 patients, and with a median size of 2.5 (range, 0.7–7.5) cm. All the patients underwent pancreatic surgery (33 standard resections, 6 limited resections). Fifteen patients had post-operative complications (morbidity 38.5%). The median DFS was 63 months, and 19 out of 36 patients showed a disease recurrence. The median OS was 134 months, and 13 out of 36 patients were alive with no evidence of disease. At univariate analysis, lymph node positivity (HR 5.1, 95% CI 1.5–18), multi-visceral resection (HR 3.4, 95% CI 1.1–10) and synchronous RCC-PMs (HR 13, 95% CI 3–55) were significantly associated with a short OS. Conclusion: Surgery may allow a DFS up to 17 years in more than one third of patients, even after limited resections. Splenectomy and lymph node dissection are not mandatory.

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Section: Discussionsupporting

confidence: 91%

A Plea for Surgery in Pancreatic Metastases from Renal Cell Carcinoma: Indications and Outcome from a Multicenter Surgical Experience

Milanetto

Morelli

Franco

et al. 2020

JCM

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“…The in-hospital mortality rate in departments performing less than 10 pancreatic procedures per year was 12% compared to 8.1% in those with 20-29 procedures and 5.8% in hospitals with at least 30 procedures. Table 1 Rates of complications specific for pancreatic surgery, as described by [2,39] Specific complication PD (%) DP (%) Regarding publications on detailed postoperative mortality and morbidity after PR in Austria, multicentre data were recently reported in one prospective trial and two retrospective registries on pancreatic cancer and neuroendocrine tumour resections [8][9][10]. These publications all included only medium-to high-volume centres, with a resulting postoperative 30-to 90day mortality of 2.4 to 3.5%, showing that pancreatic surgery in specialized Austrian units is performed within internationally accepted safety range.…”

Section: Introductionmentioning

confidence: 99%

Outcomes following pancreatic resections—results and challenges of an Austrian university hospital compared to nationwide data and international centres

et al. 2019

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Background Despite clear advances in decreasing postoperative mortality below 4% after pancreatic resections in experienced centres, specific morbidity according to standardized definitions still remains high. While some recent multicentre studies have reported on complications after pancreatic surgery in Austria, detailed outcome data from single highvolume centres over longer time-periods are scarce. This study provides an in-depth picture of patient characteristics, indications, morbidity and mortality after pancreatic surgery in an Austrian tertiary referral centre. Methods All patients undergoing curative intent resection between 2010 and 2017 at the Medical University of Innsbruck were evaluated. Patient characteristics and procedural details, overall and specific complications including postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE) and postpancreatectomy haemorrhage (PPH) rates according to accepted definitions are reported. Outcomes after pancreatic head resections, distal pancreatectomy and other types of resections are compared. Factors associated with severe and overall morbidity are evaluated by logistic regression modelling. Results A total of 343 patients underwent pancreatic resection, at a median of 64 years (53% males). Most

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“…Known risk factors for poor survival after resection of pNETs include increased tumor size, presence of metastasis, vascular and lymphogenic invasion, positive lymph nodes of the primary tumor, T-Stage and non-functioning tumors [ 9 , 27 ]. The five identified TPM cases were not found significantly related to any of the clinicopathological and epigenetic parameters in this small sample of pNEN patients.…”

Section: Discussionmentioning

confidence: 99%

“…Pancreatic neuroendocrine neoplasms (pNENs) are the second most common malignancies of the pancreas and mainly occur in elderly patients [ 8 ]. Their incidence of currently 1–2/100000 inhabitants in the United States and Europe is steadily increasing [ 9 ]. A recent multicenter study in Austria has shown 5 and 10 year survival rates after surgical resection of around 81% and 50%, respectively [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…Their incidence of currently 1–2/100000 inhabitants in the United States and Europe is steadily increasing [ 9 ]. A recent multicenter study in Austria has shown 5 and 10 year survival rates after surgical resection of around 81% and 50%, respectively [ 9 ]. A large international cohort study validated the pNEN grading system to distinguish well differentiated pNET (G1, G2, G3) and poorly differentiated pNEC (only G3 by definition) [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Hot Spot TERT Promoter Mutations Are Rare in Sporadic Pancreatic Neuroendocrine Neoplasms and Associated with Telomere Length and Epigenetic Expression Patterns

Posch

Hofer-Zeni

Klieser

et al. 2020

Cancers

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Cancer cells activate a telomere maintenance mechanism like telomerase in order to proliferate indefinitely. Telomerase can be reactivated by gain-of-function Telomerase Reverse Transcriptase (TERT) promoter mutations (TPMs) that occur in several cancer subtypes with high incidence and association with diagnosis, prognosis and epigenetics. However, such information about TPMs in sporadic pancreatic neuroendocrine neoplasms (pNENs) including tumor (pNET) and carcinoma (pNEC) is less well defined. We have studied two hot spot TPMs and telomere length (TL) in pNEN and compared the results with clinicopathological information and proliferation-associated miRNA/HDAC expression profiles. DNA was isolated from formalin-fixed paraffin-embedded (FFPE) tissue of 58 sporadic pNEN patients. T allele frequency of C250T and C228T TPM was analyzed by pyrosequencing, relative TL as telomeric content by qPCR. In total, five pNEN cases (9%) including four pNETs and one pNEC were identified with TPMs, four cases with exclusive C250T as predominant TPM and one case with both C250T and C228T. T allele frequencies of DNA isolated from adjacent high tumor cell content FFPE tissue varied considerably, which may indicate TPM tumor heterogeneity. Overall and disease-free survival was not associated with TPM versus wild-type pNEN cases. Binary category analyses indicated a marginally significant relationship between TPM status and longer telomeres (p = 0.086), and changes in expression of miR449a (p = 0.157), HDAC4 (p = 0.146) and HDAC9 (p = 0.149). Future studies with larger patient cohorts are needed to assess the true clinical value of these rare mutations in pNEN.

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Exploring the surgical landscape of pancreatic neuroendocrine neoplasia in Austria: Results from the ASSO pNEN study group

Cited by 15 publications

References 49 publications

A Plea for Surgery in Pancreatic Metastases from Renal Cell Carcinoma: Indications and Outcome from a Multicenter Surgical Experience

A Plea for Surgery in Pancreatic Metastases from Renal Cell Carcinoma: Indications and Outcome from a Multicenter Surgical Experience

Outcomes following pancreatic resections—results and challenges of an Austrian university hospital compared to nationwide data and international centres

Hot Spot TERT Promoter Mutations Are Rare in Sporadic Pancreatic Neuroendocrine Neoplasms and Associated with Telomere Length and Epigenetic Expression Patterns

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