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Implementation of Current ENETS Guidelines for Surgery of Small (≤2 cm) Pancreatic Neuroendocrine Neoplasms in the German Surgical Community: An Analysis of the Prospective DGAV StuDoQ|Pancreas Registry

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Abstract

Background

ENETS guidelines recommend parenchyma-sparing procedures without formal lymphadenectomy, ideally with a minimally invasive laparoscopic approach for sporadic small pNENs (≤2 cm). Non-functioning (NF) small pNENs can also be observed. The aim of the study was to evaluate how these recommendations are implemented in the German surgical community.

Methods

Data from the prospective StuDoQ|Pancreas registry of the German Society of General and Visceral Surgery were analyzed regarding patient’s demographics, tumor characteristics, surgical procedures, histology and perioperative outcomes.

Results

Eighty-four (29.2%) of 287 patients had sporadic pNENs ≤2 cm. Forty-three (51.2%) patients were male, and the mean age at diagnosis was 58.8 ± 15.6 years. Twenty-five (29.8%) pNENs were located in the pancreatic head. The diagnosis pNEN was preoperatively established in 53 (65%) of 84 patients. Sixty-two (73.8%) patients had formal pancreatic resections, including partial pancreaticoduodenectomy or total pancreatectomy (21.4%). Only 22 (26.2%) patients underwent parenchyma-sparing resections and 23 (27.4%) patients had minimally invasive procedures. A lymphadenectomy was performed in 63 (75.4%) patients, and lymph node metastases were diagnosed in 6 (7.2%) patients. Eighty-two (97.7%) patients had an R0 resection. Sixty (72%) tumors were classified G1, 24 (28%) tumors G2. Twenty-seven (32.2%) of 84 patients had postoperative relevant Clavien–Dindo grade ≥3 complications. Thirty- and 90-day mortalities were 2.4% and 3.6%.

Conclusions

ENETS guidelines for surgery of small pNENs are yet not well accepted in the German surgical community, since the rate of formal resections with standard lymphadenectomy is high and the minimally invasive approach is underused. The attitude to operate small NF tumors seems to be rather aggressive.

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Acknowledgements

This study has been conducted using the StuDoQ|Pancreas registry provided by the Study, Documentation, and Quality Center (Studien, Dokumentations- und Qualitätszentrum, StuDoQ) of the German Society for General and Visceral Surgery (Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, DGAV) with the ID StuDoQ-2017-0003. We would like to thank the following colleagues who actively participated in the StuDoQ|Pancreas registry and enrolled patients with pNENs.

StuDoQ|Pancreas study group of the German Society for General and Visceral Surgery (DGAV)

Prof. Dr. Michael Ghadimi, Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen, Göttingen, Germany, Prof. Dr. Stefan Post, PD Dr. Torsten J. Wilhelm, Chirurgische Klinik, Universitätsmedizin Mannheim, Mannheim, Germany, Prof. Dr. Christoph-Thomas Germer, Klinik & Poliklinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinik Würzburg, Würzburg, Germany, Prof. Dr. Waldemar Uhl, PD Dr. med. Orlin Belyaev, Klinik für Allgemein- und Viszeralchirurgie, St. Josef-Hospital, Bochum, Germany, Prof. Dr. Thomas Kraus, Allgemeine, Viszeral und Minimalinvasive Chirurgie, Nordwestkrankenhaus Frankfurt, Frankfurt, Germany, Prof. Dr. Helmut Witzigmann, Allgemein- und Viszeralchirurgie, Städtisches Klinikum Dresden Friedrichstadt, Dresden, Germany, Prof. Dr. Merten Hommann, Zentralklinik Bad Berka, Bad Berka, Germany, Prof. Dr. Ernst Klar, Allgemeine-, Thorax-, Gefäß- und Transplantationschirurgie, Universitätsmedizin Rostock, Rostock, Germany, Prof. Dr. Matthias Glanemann, Klinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Homburg an der Saar, Germany, Prof. Dr. Carsten Gutt, Allgemein-, Visceral-, Gefäß- und Thoraxchirurgie, Klinikum Memmingen, Memmingen, Germany, Prof. Dr. Thomas Manger, Abteilung für Allgemeine-, Viszeral- und Kinderchirurgie, SRH Waldklinikum Gera, Gera, Germany, Prof. Dr. Hans-Jörg Krämling, Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, EvK Düsseldorf, Düsseldorf, Germany, Prof. Dr. Jörg C. Kalff, PD Dr. Tim R. Glowka, Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Bonn, Germany, Prof. Dr. Natascha C. Nüssler, Klinik für Allgemein- und Viszeralchirurgie, Endokrine Chirurgie und Coloproktologie, Städt. Klinikum München GmbH, Klinikum Neuperlach, München, Germany, Prof. Dr. Jörg-Peter Ritz, Klinik für Allgemein- und Viszeralchirurgie, Helios Kliniken Schwerin, Schwerin, Germany, Prof. Dr. Winfried Padberg, Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen Marburg Standort Gießen, Giessen, Germany, Prof. Dr. Anton J. Kroesen, Klinik für Allgemein-, Viszeral- und Unfallchirurgie, Krankenhaus Porz am Rhein, Köln, Germany, Prof. Dr. Albrecht Stier, Klinik für Allgemein- und Viszeralchirurgie, Helios-Klinik Erfurt, Erfurt, Germany, Prof. Dr. Dietmar Lorenz, Chirurgische Klinik I, Sana Klinikum Offenbach, Offenbach, Germany, Prof. Dr. Wolf Otto Bechstein, Kllinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Frankfurt, Frankfurt, Germany, Prof. Karl-Jürgen Oldhafer, Allgemein- und Viszeralchirurgie, Asklepios Klinik Barmbek, Hamburg, Germany, PD Dr. Sven Eisold, Klinik für Allgemein- und Viszeralchirurgie, Sana Kliniken Lübeck GmbH, Lübeck, Germany, Dr. med. Ute Tröbs, Allgemein- und Viszeralchirurgie, Kreiskrankenhaus Delitzsch, Delitzsch, Germany, Prof. Dr. Hans-Bernd Reith, Allgemein- und Viszeralchirurgie, Agaplesion Diakoniekliniken Kassel, Kassel, Germany, Dr.med. Franz-Josef Schumacher, Klinik für Allgemein- und Viszeralchirurgie, Katholische Kliniken Oberhausen, Oberhausen, Germany, Prof. Dr. Elke Wagler, Allgemein-, Visceral- und Onkochirurgie, Pleißental-Klinik GmbH, Werdau, Germany, Prof. Dr. Stefan Farkas, Klinik für Allgemein- und Visceralchirurgie, Wiesbaden, Germany, Dr. med. Frank Klammer, Allgemein-, Viszeral- und Thoraxchirurgie, St. Franziskus-Hospital, Ahlen, Germany, Prof. Dr. Matthias Schwarzbach, Klinik für Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie, Klinikum Frankfurt-Höchst, Frankfurt, Germany, Prof. Dr. Marco Niedergethmann, Klinik für Allgemein- und Viszeralchirurgie, Alfried-Krupp-Krankenhaus, Essen, Germany, Prof. Dr. Norbert Runkel, Allgemein-, Viszeral- und Kinderchirurgie, Schwarzwald-Baar-Klinikum, Villingen-Schwenningen, Germany, Prof. Dr. Pompiliu Piso, Chirurgie I, Barmherzige Brüder Regensburg, Regensburg, Germany, Dr. med. Eric P.M. Lorenz, Viszeralchirurgie, Alexianer KH Hedwigshöhe, Berlin, Germany, PD Dr. Christian Mönch, Dr. Steffanie Bieck, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Westpfalz-Klinikum Kaiserslautern, Kaiserslautern, Germany, Prof. Dr. Robert Grützmann, Dr. Max Brunner, Chirurgische Klinik, Universitätsklinikum Erlangen, Erlangen, Germany, Prof. Dr. Helmut Friess, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, TUM, München, Germany.

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Authors and Affiliations

  1. Department of Visceral-, Thoracic- and Vascular Surgery, Philipps-University Marburg, Baldingerstrasse, 35043, Marburg, Germany

    Ioannis Mintziras & Detlef Klaus Bartsch

  2. Clinic for Surgery, University Clinic Schleswig-Holstein, UKSH Campus Lübeck, Lübeck, Germany

    Tobias Keck

  3. Department of General, Visceral, Vascular and Transplant Surgery, Klinikum der Universität München, Munich, Germany

    Jens Werner

  4. Department of General and Visceral Surgery, University Clinic Freiburg, Freiburg, Germany

    Stefan Fichtner-Feigl & Uwe Wittel

  5. Department of General and Visceral Surgery, University Clinic Münster, Münster, Germany

    Norbert Senninger & Thorsten Vowinkel

  6. Department of General and Visceral Surgery, Katharinenhospital, Stuttgart, Germany

    Jörg Köninger

  7. Department of General, Visceral and Transplant Surgery, Klinikum Augsburg, Augsburg, Germany

    Matthias Anthuber & Bernd Geißler

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  1. Ioannis Mintziras
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Consortia

for the StuDoQ|Pancreas study group of the German Society for General and Visceral Surgery (DGAV)

  • Michael Ghadimi
  • , Stefan Post
  • , Torsten J. Wilhelm
  • , Christoph-Thomas Germer
  • , Waldemar Uhl
  • , Orlin Belyaev
  • , Thomas Kraus
  • , Helmut Witzigmann
  • , Merten Hommann
  • , Ernst Klar
  • , Matthias Glanemann
  • , Carsten Gutt
  • , Thomas Manger
  • , Hans-Jörg Krämling
  • , Jörg C. Kalff
  • , Tim R. Glowka
  • , Natascha C. Nüssler
  • , Jörg-Peter Ritz
  • , Winfried Padberg
  • , Anton J. Kroesen
  • , Albrecht Stier
  • , Dietmar Lorenz
  • , Wolf Otto Bechstein
  • , Karl-Jürgen Oldhafer
  • , Sven Eisold
  • , Ute Tröbs
  • , Hans-Bernd Reith
  • , Franz-Josef Schumacher
  • , Elke Wagler
  • , Stefan Farkas
  • , Frank Klammer
  • , Matthias Schwarzbach
  • , Marco Niedergethmann
  • , Norbert Runkel
  • , Pompiliu Piso
  • , Eric P. M. Lorenz
  • , Christian Mönch
  • , Steffanie Bieck
  • , Robert Grützmann
  • , Max Brunner
  •  & Helmut Friess

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Correspondence to Ioannis Mintziras.

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Mintziras, I., Keck, T., Werner, J. et al. Implementation of Current ENETS Guidelines for Surgery of Small (≤2 cm) Pancreatic Neuroendocrine Neoplasms in the German Surgical Community: An Analysis of the Prospective DGAV StuDoQ|Pancreas Registry. World J Surg 43, 175–182 (2019). https://doi.org/10.1007/s00268-018-4751-2

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