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Association of a Pr...
Association of a Prophylactic surgical approach to Stage IV Small Intestinal Neuroendocrine Tumors with Survival.
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- Daskalakis, Kosmas (author)
- Uppsala universitet,Endokrinkirurgi
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- Karakatsanis, Andreas (author)
- Uppsala universitet,Endokrinkirurgi
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- Hessman, Ola (author)
- Uppsala universitet,Endokrinkirurgi
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- Stuart, Heather C. (author)
- Division of Surgical Oncology, University of Miami, Florida, USA
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- Welin, Staffan (author)
- Uppsala universitet,Onkologisk endokrinologi
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- Tiensuu Janson, Eva (author)
- Uppsala universitet,Onkologisk endokrinologi
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- Öberg, Kjell, 1946- (author)
- Uppsala universitet,Endokrin tumörbiologi
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- Hellman, Per (author)
- Uppsala universitet,Endokrinkirurgi
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- Norlén, Olov (author)
- Uppsala universitet,Endokrinkirurgi
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- Stålberg, Peter (author)
- Uppsala universitet,Endokrinkirurgi
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(creator_code:org_t)
- American Medical Association (AMA), 2018
- 2018
- English.
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In: JAMA Oncology. - : American Medical Association (AMA). - 2374-2437 .- 2374-2445. ; 4:2, s. 183-189
- Related links:
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https://jamanetwork....
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- Importance: Primary tumor resection and mesenteric lymph node dissection in asymptomatic patients with stage IV Small Intestinal Neuroendocrine Tumors (SI-NETs) is controversial.Objective: To determine whether locoregional surgery performed at diagnosis in asymptomatic SI-NETs patients with distant metastases affects overall survival (OS), morbidity and mortality, length of hospital stay (LOS) and re-operation rates.Design: This investigation was a cohort study of asymptomatic patients with stage IV SI-NET, diagnosed between 1985 and 2015, using the prospective Uppsala database of SI-NETs and the Swedish National Patient Register. Patients included were followed until May 2016 and divided to a first group, which underwent Prophylactic Upfront Surgery within six months from diagnosis Combined with Oncological treatment (PUSCO group) and a second group, which was either treated non-surgically or operated later (Delayed Surgery As Needed Combined with Oncological treatment [DSANCO group]).Setting: A tertiary referral center with follow-up data from the Swedish National Patient Register.Participants: We included 363 stage IV SI-NET patients without any abdominal symptoms within 6 months from diagnosis, treated either with PUSCO (n=161) or DSANCO (n=202).Exposure: PUSCO vs DSANCO.Main Outcomes and Measures: Overall survival (OS), length of hospital stay (LOS), postoperative morbidity and mortality and re-operation rates measured from baseline. Propensity score match was performed between the two groups.Results: Two isonumerical groups (n=91) occurred after propensity score matching. There was no difference between groups in OS (PUSCO median 7.9 vs DSANCO 7.6 years; [hazard ratio] HR, 0.98; [95% CI, 0.70-1.37]; log-rank P=.93) and cancer-specific survival (median 7.7 vs 7.6 years, HR, 0.99; [95%CI, 0.71-1.40]; log-rank P=.99). There was no difference in 30-day mortality (0% in both matched groups) or postoperative morbidity (2% vs 1%; P>.99), LOS (median 73 vs 76 days; P=.64), LOS due to local tumor-related symptoms (median 7 vs 11.5 days; P=.81) or incisional hernia repairs (4% in both groups; P>.99). Patients from the PUSCO group underwent more re-operative procedures (14%) compared to the DSANCO group (3%) due to intestinal obstruction (P< .001).Conclusion: Prophylactic upfront locoregional surgery confers no survival advantage in asymptomatic stage IV SI-NET patients. Delayed surgery as needed seems to be comparable in all examined outcomes, whilst offering the advantage of less re-operations for intestinal obstruction. The value of a priori locoregional surgery in the presence of distant metastases is challenged and needs to be elucidated in a randomized controlled study.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
Keyword
- Small Intestinal NETs
- prophylactic loco-regional surgery
- stage IV
Publication and Content Type
- ref (subject category)
- art (subject category)
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To the university's database
- By the author/editor
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Daskalakis, Kosm ...
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Karakatsanis, An ...
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Hessman, Ola
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Stuart, Heather ...
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Welin, Staffan
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Tiensuu Janson, ...
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Öberg, Kjell, 19 ...
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Hellman, Per
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Norlén, Olov
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Stålberg, Peter
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Surgery
- Articles in the publication
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JAMA Oncology
- By the university
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Uppsala University