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Long-term outcome of surgical resection in patients with gastroenteropancreatic neuroendocrine neoplasia: results from a German nation-wide multi-centric registry

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Abstract

Background

Neuroendocrine neoplasia (NEN) are rare and heterogenous tumours. Few data exist on the impact of surgical therapy.

Materials and methods

This is a retrospective analysis of prospectively collected data of gastroenteropancreatic NEN in the German NET-Registry (1999–2012). It focuses on patients without distant metastases (limited disease, LD, stage I–IIIB).

Results

Data of 2239 patients with NEN were recorded. Median age was 59 years, the gender ratio was 1:1.3 (f:m). A total of 986 patients (44%) had LD, and the 5-year survival rate (5 years) was 77% for all and 90% for patients with LD. A total of 1635 patients (73%) received a surgical therapy (1st to 6th line); the 5 and 10 ysr were 83/65% after and 59/35% without surgery for all patients (p < .001). The resection margins in the LD patients were 76%, 16%, and 3% for R0, R1 and R2, respectively. The 10 ysr was 84%, 59% and 42% for R0, R1 and R2 resections, respectively (p = .021 R0/R1, p < .001 R0/R2). The R0 resection rate was 75% for G1/G2 NET and 67% for G3 NEC.

Conclusion

The rate of complete tumour resection (R0) in LD is independent of tumour grading, and R0 resection is the key determinant of long-term survival, as demonstrated by the 10 ysr. of 84%. All NEN patients with limited disease should be considered for operation, if possible, as the best 10-year survival is shown after an R0 resection.

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Acknowledgements

We thank Company Lohmann and Birkner, Berlin, for hosting the German NET-Registry and Mrs. Gisela Skrobek-Engel for great support in the data entry. Thanks to the German Society of Endocrinology (DGE) for patronaging and to Novartis Pharma, Ipsen Pharma, and Pfizer for funding the German NET-Registry.

Author information

Author notes

  1. Nehara Begum, Sebastian Maasberg, Ulrich-Frank Pape and Peter E. Goretzki contributed equally to this work.

Authors and Affiliations

  1. Department for General-, Visceral- and Minimalinvasive Surgery, Agaplesion Evangelisches Klinikum Schaumburg, Obernkirchen, Germany

    Nehara Begum

  2. Department for Internal Medicine and Gastroenterology, Asklepios Hospital St. Georg, Lohmühlenstrasse 5, Hamburg, Germany

    Sebastian Maasberg & Ulrich-Frank Pape

  3. Department of Hepatology and Gastroenterology, Campus Virchow Clinic, Charite, University Medicine Berlin, Berlin, Germany

    Sebastian Maasberg & Ulrich-Frank Pape

  4. Department General-, Visceral- and Transplant Surgery, University Hospital Münster, Münster, Germany

    Andreas Pascher

  5. Centre of Metabollism: Endocrinology, Diabetes and Metabolism, Campus Virchow Clinic, Charite University-Medicine Berlin, Berlin, Germany

    Ursula Plöckinger

  6. Department of Gastroenterology and Endocrinology, University Hospital Marburg (UKGM), Marburg, Germany

    Thomas M. Gress & Anja Rinke

  7. Department of Surgery, Klinikum Crailsheim, Crailsheim, Germany

    Christine Wurst

  8. Department of General-, Visceral- and Transplantation Surgery, Division of Endocrine Surgery, Medical Faculty, University Duisburg-Essen, Duisburg, Germany

    Frank Weber

  9. Department for General-, Visceral- and Endocrine Surgery, Marienhospital Gelsenkirchen, Gelsenkirchen, Germany

    Andreas Raffel & Markus Krausch

  10. Department of Visceral-, Thoracic- and Vascular Surgery, Section of Endocrine Surgery, University Hospital Marburg (UKGM), Marburg, Germany

    Katharina Holzer

  11. Department of Visceral-, Thoracic- and Vascular Surgery, University Hospital Marburg (UKGM), Marburg, Germany

    Detlef K. Bartsch

  12. Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University Medicine Mainz, Mainz, Germany

    Thomas J. Musholt

  13. Department of General Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany

    Tobias Keck

  14. Pathological Institute, Limburg, Germany

    Martin Anlauf

  15. Department of General, Visceral and Transplant Surgery, Section of Endocrine Surgery, Charite, University Medicine Berlin, Berlin, Germany

    Peter E. Goretzki

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  1. Nehara Begum
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On behalf of the German NET-Registry

Corresponding author

Correspondence to Nehara Begum.

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Conflict of interest

Author Rinke, Anja received honoraria from Ipsen Pharma and Novartis Pharma. All other authors declare that they have no conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. National ethical approval was given by the ethic committee of the Charite, University Hospital, approval no. EA1/279/13.

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Informed consent was obtained from all individual participants included in the study.

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Begum, N., Maasberg, S., Pascher, A. et al. Long-term outcome of surgical resection in patients with gastroenteropancreatic neuroendocrine neoplasia: results from a German nation-wide multi-centric registry. Langenbecks Arch Surg 405, 145–154 (2020). https://doi.org/10.1007/s00423-020-01868-1

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