Role of Palliative Resection of the Primary Tumour in Advanced Pancreatic and Small Intestinal Neuroendocrine Tumours: A Systematic Review and Meta-analysis

Publication date: Available online 25 May 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): L. Max Almond, James Hodson, Samuel Ford, David Gourevitch, Keith J. Roberts, Tahir Shah, John Isaac, Anant Desai
PurposeThis study aimed to evaluate the impact on overall survival following palliative surgery to remove the primary lesion in unresectable metastatic small intestinal (SI-NET) and pancreatic neuroendocrine tumours (P-NET).MethodsA systematic review of the literature and meta-analysis was performed. MEDLINE and Embase databases were searched to identify articles comparing patients undergoing palliative primary tumour resection without metastatectomy vs. no resection. Relevant articles were identified in accordance with PRISMA guidelines. The primary outcome was overall survival. Included studies were evaluated for heterogeneity and publication bias.Results13 studies met the inclusion criteria, of which 6 presented data suitable for meta-analysis. No randomised controlled trials were identified. Analysis of pooled multivariate hazard ratios demonstrated significantly longer overall survival in patients undergoing resection of both P-NETs (HR 0.43; 95% CI: 0.34 - 0.57, p<0.001) and SI-NETs (HR 0.47; 95% CI: 0.35 - 0.55, p=0.007). The increase in median survival in patients treated surgically relative to non-surgically ranged from 14 to 46 months in P-NET, and 22 to 112 months in SI-NET. The number needed to treat in order that one additional patient was alive at five years, ranged from 3.0 to 4.2, and 1.7 to 7.7 respectively.ConclusionsMeta-analysis demonstrates that palliative resection of primary SI-NETs and P-NETs in the setting of unresectable metastatic disease can increase survival. Although these results should be interpreted with caution due to potential selection and publication bias, the data supports consideration of surgery, particularly in patients with low tumour burdens and good functional status.

Synopsis

The role of palliative resection of the primary tumour in small intestinal (SI-NET) and pancreatic neuroendocrine tumours (P-NET) was evaluated through systematic review and meta-analysis. Overall survival was significantly longer in patients undergoing palliative resection of both P-NETs (HR 0.43; 95% CI: 0.34 - 0.57, p<0.001) and SI-NETs (HR 0.47; 95% CI: 0.35 - 0.55, p=0.007).


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