回肠神经内分泌肿瘤微创手术后的长期生存结果。
Long-Term Survival Outcomes After Minimally Invasive Surgery for Ileal Neuroendocrine Tumors.
发表日期:2024 May 26
作者:
Akitada Yogo, Alan Paciorek, Yosuke Kasai, Farhana Moon, Kenzo Hirose, Carlos U Corvera, Emily K Bergsland, Eric K Nakakura
来源:
ANNALS OF SURGICAL ONCOLOGY
摘要:
回肠神经内分泌肿瘤(i-NET)的特点是多灶性和巨大的肠系膜肿块。已经证明利用手动端口装置的微创手术 (MIS) 具有良好的短期结果并实现了 i-NET 手术的目标,我们试图分析 MIS 的长期生存结果。 160回顾性研究了 2007 年 1 月至 2023 年 2 月期间在同一机构接受原发性 i-NET 切除术的 8 名患者。患者根据意向治疗被分为 MIS 组或开放手术组。选择开放手术主要是根据需要进行肝切除术或大块肠系膜肿块切除术。使用倾向评分匹配 (PSM) 和 Cox 比例风险回归的对数秩检验分析总体生存率。进行 PSM 是为了将变量的标准化平均差异降低至 <0.2。总体而言,129 名 (77%) 患者接受了 MIS,39 名 (23%) 患者接受了开放手术。 27 名 MIS 患者转为开放手术。中位随访时间为 49 个月(四分位数范围 23-87 个月)。在 PSM 队列中,MIS 队列和开放手术队列之间的总生存期没有显着差异(中位数为 99 个月(95% 置信区间 [CI] 91-不适用 [NA])与 103 个月(95% CI 86-NA) ,p = 0.77;风险比 0.87 (95% CI 0.33-2.2),p = 0.77}。MIS 是 i-NET 开放手术的替代方案,可实现类似的短期和长期肿瘤学结果。巨大的肠系膜肿块和同时进行肝脏切除的计划是开放手术的潜在标准。© 2024。作者。
Ileal neuroendocrine tumors (i-NETs) are characterized by their multifocality and bulky mesenteric mass. Having shown that minimally invasive surgery (MIS) utilizing a hand-access port device has favorable short-term outcomes and achieves the goals of surgery for i-NETs, we sought to analyze long-term survival outcomes of MIS.One hundred and sixty-eight patients who underwent resection of primary i-NETs at a single institution between January 2007 and February 2023 were retrospectively studied. Patients were categorized into the MIS or open surgery cohorts on an intention-to-treat basis. Open surgery was selected mainly based on the need for hepatectomy or bulky mesenteric mass resection. Overall survival was analyzed using log-rank tests with propensity score matching (PSM) and Cox proportional hazards regression. PSM was performed to reduce standardized mean differences of the variables to <0.2.Overall, 129 (77%) patients underwent MIS and 39 (23%) underwent open surgery. Twenty-seven MIS patients were converted to an open procedure. The median follow-up time was 49 months (interquartile range 23-87 months). In the PSM cohorts, overall survival did not differ significantly between the MIS and open surgery cohorts {median 99 months (95% confidence interval [CI] 91-not applicable [NA]) vs. 103 months (95% CI 86-NA), p = 0.77; hazard ratio 0.87 (95% CI 0.33-2.2), p = 0.77}.MIS is an alternative to open surgery for i-NETs, achieving similar short- and long-term oncological outcomes. Bulky mesenteric mass and a plan for concurrent liver resection are potential criteria for open surgery.© 2024. The Author(s).