Abstract
Purpose
This 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).
Methods
A 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.
Results
13 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 22–112 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.
Conclusions
Meta-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.
Keywords
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Article info
Publication history
Published online: May 24, 2017
Accepted:
May 15,
2017
Identification
Copyright
Crown Copyright © 2017 Published by Elsevier Ltd. All rights reserved.
