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Association of a Pr...
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Daskalakis, KosmasUppsala universitet,Endokrinkirurgi
(author)
Association of a Prophylactic surgical approach to Stage IV Small Intestinal Neuroendocrine Tumors with Survival.
- Article/chapterEnglish2018
Publisher, publication year, extent ...
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American Medical Association (AMA),2018
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printrdacarrier
Numbers
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LIBRIS-ID:oai:DiVA.org:uu-330702
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-330702URI
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https://doi.org/10.1001/jamaoncol.2017.3326DOI
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Language:English
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Summary in:English
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
Notes
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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.
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Karakatsanis, AndreasUppsala universitet,Endokrinkirurgi(Swepub:uu)andka774
(author)
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Hessman, OlaUppsala universitet,Endokrinkirurgi(Swepub:uu)olahessm
(author)
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Stuart, Heather C.Division of Surgical Oncology, University of Miami, Florida, USA
(author)
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Welin, StaffanUppsala universitet,Onkologisk endokrinologi(Swepub:uu)stafweli
(author)
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Tiensuu Janson, EvaUppsala universitet,Onkologisk endokrinologi(Swepub:uu)evatieja
(author)
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Öberg, Kjell,1946-Uppsala universitet,Endokrin tumörbiologi(Swepub:uu)kjellob
(author)
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Hellman, PerUppsala universitet,Endokrinkirurgi(Swepub:uu)perhellm
(author)
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Norlén, OlovUppsala universitet,Endokrinkirurgi(Swepub:uu)olono376
(author)
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Stålberg, PeterUppsala universitet,Endokrinkirurgi(Swepub:uu)petestah
(author)
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Uppsala universitetEndokrinkirurgi
(creator_code:org_t)
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In:JAMA Oncology: American Medical Association (AMA)4:2, s. 183-1892374-24372374-2445
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- MEDICAL AND HEALTH SCIENCES
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and Surgery
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JAMA Oncology
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