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The Need for Centralization for Small Intestinal Neuroendocrine Tumor Surgery: A Cohort Study from the GTE-Endocan-RENATEN Network, the CentralChirSINET Study.
Kalifi, Maroin; Deguelte, Sophie; Faron, Matthieu; Afchain, Pauline; de Mestier, Louis; Lecomte, Thierry; Pasquer, Arnaud; Subtil, Fabien; Alghamdi, Khalid; Poncet, Gilles; Walter, Thomas.
Afiliação
  • Kalifi M; Department of Digestive Surgery, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon Cedex 03, France.
  • Deguelte S; Department of Digestive Surgery, Reims University Hospital, Robert Debré Hospital, Reims, France.
  • Faron M; Departments of Surgical Oncology and Statistics, Gustave Roussy Cancer Campus® Grand Paris, Villejuif, France.
  • Afchain P; Department of Oncology, CHU Saint-Antoine, APHP, Paris, France.
  • de Mestier L; Department of Pancreatology and Digestive Oncology, ENETS Centre of Excellence, Beaujon Hospital (APHP Nord), Université Paris-Cité, Clichy, France.
  • Lecomte T; Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital of Tours, UMR INSERM 1069, Tours University, Tours, France.
  • Pasquer A; Department of Digestive Surgery, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon Cedex 03, France.
  • Subtil F; Gastroenterology and Technologies for Health, Research Unit INSERM UMR 1052 CNRS UMR 5286, Cancer Research Center of Lyon, Lyon, France.
  • Alghamdi K; Department of Biostatistic, Hospices Civils de Lyon, Lyon, France.
  • Poncet G; King Abdulaziz University, Jeddah, Saudi Arabia.
  • Walter T; Department of Digestive Surgery, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon Cedex 03, France. gilles.poncet@chu-lyon.fr.
Ann Surg Oncol ; 30(13): 8528-8541, 2023 Dec.
Article em En | MEDLINE | ID: mdl-37814184
ABSTRACT

BACKGROUND:

The concept of surgical centralization is becoming more and more accepted for specific surgical procedures.

OBJECTIVE:

The aim of this study was to evaluate the relationship between procedure volume and the outcomes of surgical small intestine (SI) neuroendocrine tumor (NET) resections.

METHODS:

We conducted a retrospective national study that included patients who underwent SI-NET resection between 2019 and 2021. A high-volume center (hvC) was defined as a center that performed more than five SI-NET resections per year. The quality of the surgical resections was evaluated between hvCs and low-volume centers (lvCs) by comparing the number of resected lymph nodes (LNs) as the primary endpoint.

RESULTS:

A total of 157 patients underwent surgery in 33 centers 90 patients in four hvCs and 67 patients in 29 lvCs. Laparotomy was more often performed in hvCs (85.6% vs. 59.7%; p < 0.001), as was right hemicolectomy (64.4% vs. 38.8%; p < 0.001), whereas limited ileocolic resection was performed in 18% of patients in lvCs versus none in hvCs. A bi-digital palpation of the entire SI length (95.6% vs. 34.3%, p < 0.001), a cholecystectomy (93.3% vs. 14.9%; p < 0.001), and a mesenteric mass resection (70% vs. 35.8%; p < 0.001) were more often performed in hvCs. The proportion of patients with ≥8 LNs resected was significantly higher (96.3% vs. 65.1%; p < 0.001) in hvCs compared with lvCs, as was the proportion of patients with ≥12 LNs resected (87.8% vs. 52.4%). Furthermore, the number of patients with multiple SI-NETs was higher in the hvC group compared with the lvC group (43.3% vs. 25.4%), as were the number of tumors in those patients (median of 7 vs. 2; p < 0.001).

CONCLUSIONS:

Optimal SI-NET resection was significantly more often performed in hvCs. Centralization of surgical care of SI-NETs is recommended.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Tumores Neuroendócrinos Tipo de estudo: Etiology_studies / Observational_studies Limite: Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Tumores Neuroendócrinos Tipo de estudo: Etiology_studies / Observational_studies Limite: Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article