Comparison of EUS-guided ablation and surgical resection for nonfunctioning small pancreatic neuroendocrine tumors: a propensity score-matching study

Hoonsub So; Sung Woo Ko; Seung Hwan Shin; Eun Ha Kim; Jimin Son; SuHyun Ha; Ki Byung Song; Hwa Jung Kim; Myung-Hwan Kim; Do Hyun Park

doi:10.1016/j.gie.2022.11.004

Comparison of EUS-guided ablation and surgical resection for nonfunctioning small pancreatic neuroendocrine tumors: a propensity score-matching study

Gastrointest Endosc. 2023 Apr;97(4):741-751.e1. doi: 10.1016/j.gie.2022.11.004. Epub 2022 Nov 16.

Authors

Hoonsub So¹, Sung Woo Ko², Seung Hwan Shin³, Eun Ha Kim³, Jimin Son⁴, SuHyun Ha⁴, Ki Byung Song⁴, Hwa Jung Kim⁵, Myung-Hwan Kim³, Do Hyun Park³

Affiliations

¹ Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
² Department of Internal Medicine, The Catholic University of Korea, Eunpyeong St Mary's Hospital, Seoul, South Korea.
³ Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
⁴ Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
⁵ Department of Clinical Epidemiology and Biostatistics, Department of Preventive Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

PMID: 36400239
DOI: 10.1016/j.gie.2022.11.004

Abstract

Background and aims: Treatment strategies for small pancreatic neuroendocrine tumors (PNETs) <2 cm in size are still under debate. The feasibility and safety of EUS-guided ethanol ablation (EUS-EA) have been demonstrated. However, sample sizes in previous studies were small with no comparative studies on surgery. Therefore, we aimed to compare the safety and long-term outcomes of EUS-EA with those of surgery for the management of nonfunctioning small PNETs.

Methods: We retrospectively reviewed patients with PNETs who were managed by EUS-EA (from 2011 to 2018) and surgery (from 2000 to 2018) at Asan Medical Center. Propensity score matching (PSM) was performed to increase comparability. The primary outcome was early and late major adverse events (Clavien-Dindo grade ≥III) after treatment. Secondary outcomes were 10-year overall (OS) and disease-specific survival (DSS) rates, length of hospital stay, and development of endocrine pancreatic insufficiency.

Results: Of all patients, 97 and 188 patients were included in the EUS-EA and surgery groups, respectively. PSM created 89 matched pairs. EUS-EA was associated with a significantly lower rate of early major adverse events (0% vs 11.2%, P = .003). Late major adverse events occurred more frequently after surgery, with no significant difference between groups (3.4% vs 10.1%, P = .07). Both treatment modalities showed comparable 10-year OS and DSS rates. The length of hospital stay was significantly shorter in the EUS-EA group (4 days vs 14.1 days, P < .001), and endocrine pancreatic insufficiency was less common after EUS-EA than after surgery (33.3% vs 48.6%, P = .121).

Conclusions: EUS-EA had fewer adverse events and a shorter hospital stay with similar OS and DSS rates compared with surgery, suggesting that EUS-EA may be a preferred alternative to surgical resection in selected patients with nonfunctioning small PNETs.

MeSH terms

Humans
Neuroectodermal Tumors, Primitive*
Neuroendocrine Tumors* / surgery
Pancreatic Neoplasms* / pathology
Pancreatic Neoplasms* / surgery
Propensity Score
Retrospective Studies
Treatment Outcome

Supplementary concepts

Non functioning pancreatic endocrine tumor