Long-Term Outcomes after Elective versus Emergency Surgery for Small Bowel Neuroendocrine Tumors
Long-Term Outcomes after Elective versus Emergency Surgery for Small Bowel Neuroendocrine Tumors
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小肠神经内分泌肿瘤择期手术与急诊手术后的长期结果
DOI：
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
F. Amersi
中科院分区：
文献类型：
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作者：
N. Manguso;A. Gangi;N. Nissen;A. Harit;Emily Siegel;A. Hendifar;F. Amersi
小肠神经内分泌肿瘤(SBNETs)通常无痛，但偶尔出现急性症状的患者需要紧急手术干预。我们的目的是确定SBNETs的急诊手术是否会影响长期结果。对一个机构数据库进行了审查，以确定1990年至2015年期间确诊的SBNET患者。比较急诊切除(ER)和择期切除(ELR)的必要性。134名患者符合纳入标准。中位年龄59岁(21-91岁)，中位肿瘤大小1.5 cm(0.1-5岁)。中位随访期为5.5年。100例(74.6%)患者接受ELR，34例(25.4%)需要ER。ELR组的淋巴结清除量较高(中位数12.5vs8ER，P=0.04)，但阳性结节数无差异(中位数3vs2，P=0.85)。复发45例(33.6%)，ELR 31例(31.0%)，ER 14例(41.7%)，P=0.29；死亡13例(9.7%)，ELR 7例(7.0%)，ER 6例(17.6%)。两组5年无瘤生存率(ELR 72.6%vs ER 77.9%，P=0.71)和总生存率(ELR 97.2%vs ER 96.6%，P=0.81)无显著差异。虽然接受ER的患者切除的淋巴结明显较少，但他们的复发率和长期结果与接受ER的患者相当。
Small bowel neuroendocrine tumors (SBNETs) are often indolent, but occasionally, patients present with acute symptoms requiring emergent operative intervention. Our aim was to determine whether emergency surgery for SBNETs affects long-term outcomes. An institutional database was reviewed to identify patients with SBNET diagnosed between 1990 and 2015. Need for emergency resection (ER) was compared with elective resection (ELR). One hundred and thirty-four patients met inclusion criteria. Median age was 59 years (range, 21–91), and median tumor size was 1.5 cm (range, 0.1–5). Median follow-up time was 5.5 years. One hundred (74.6%) patients had ELR, whereas 34 (25.4%) required ER. ELR had a higher number of lymph nodes resected (median 12.5 vs 8 ER, P = 0.04); however, there was no difference in the number of positive nodes (median 3 vs 2, P = 0.85). There were 45 (33.6%) recurrences (31 [31.0%] ELR vs 14 [41.7%] ER, P = 0.29) and 13 (9.7%) deaths (7 [7.0%] ELR; 6 [17.6%] ER). There was no significant difference in 5-year disease-free survival (ELR 72.6% vs ER 77.9%, P = 0.71) or overall survival (ELR 97.2% vs ER 96.6%, P = 0.81). Although patients undergoing ER have significantly fewer lymph nodes resected, they have comparable recurrence rates and long-term outcomes with those patients undergoing ER.