Endoscopic Ultrasound-guided Radiofrequency Ablation Versus Surgical Resection for Treatment of Pancreatic Insulinoma
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is emerging as a safe and effective treatment for pancreatic neuroendocrine tumors. We aimed to compare EUS-RFA and surgical resection for the treatment of pancreatic insulinoma (PI).
Methods
Patients with sporadic PI who underwent EUS-RFA at 23 centers or surgical resection at 8 high-volume pancreatic surgery institutions between 2014 and 2022 were retrospectively identified and outcomes compared using a propensity-matching analysis. Primary outcome was safety. Secondary outcomes were clinical efficacy, hospital stay, and recurrence rate after EUS-RFA.
Results
Using propensity score matching, 89 patients were allocated in each group (1:1), and were evenly distributed in terms of age, sex, Charlson comorbidity index, American Society of Anesthesiologists score, body mass index, distance between lesion and main pancreatic duct, lesion site, size, and grade. Adverse event (AE) rate was 18.0% and 61.8% after EUS-RFA and surgery, respectively (P < .001). No severe AEs were observed in the EUS-RFA group compared with 15.7% after surgery (P < .0001). Clinical efficacy was 100% after surgery and 95.5% after EUS-RFA (P = .160). However, the mean duration of follow-up time was shorter in the EUS-RFA group (median, 23 months; interquartile range, 14-31 months vs 37 months; interquartile range, 17.5-67 months in the surgical group; P < .0001). Hospital stay was significantly longer in the surgical group (11.1 ± 9.7 vs 3.0 ± 2.5 days in the EUS-RFA group; P < .0001). Fifteen lesions (16.9%) recurred after EUS-RFA and underwent a successful repeat EUS-RFA (11 patients) or surgical resection (4 patients).
Conclusion
EUS-RFA is safer than surgery and highly effective for the treatment of PI. If confirmed in a randomized study, EUS-RFA treatment can become first-line therapy for sporadic PI.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | Clinical Gastroenterology and Hepatology |
| Vol/bind | 21 |
| Udgave nummer | 11 |
| Sider (fra-til) | 2834-2843.e2 |
| ISSN | 1542-3565 |
| DOI | |
| Status | Udgivet - 2023 |
Bibliografisk note
Funding Information:
Stefano Francesco Crinò, MD (Conceptualization: Lead; Data curation: Lead; Investigation: Lead; Methodology: Lead; Writing – original draft: Lead; Writing – review & editing: Lead), Bertrand Napoleon, MD (Data curation: Equal; Investigation: Lead; Writing – review & editing: Supporting), Antonio Facciorusso, MD, PhD (Formal analysis: Lead; Methodology: Equal; Writing – original draft: Equal), Sundeep Lakhtakia, MD (Data curation: Equal; Investigation: Lead), Ivan Borbath, MD (Data curation: Equal; Investigation: Equal), Fabrice Caillol, MD (Data curation: Equal; Investigation: Equal), Khanh Do-Cong Pham, MD (Data curation: Equal; Investigation: Equal), Gianenrico Rizzatti, MD (Data curation: Equal; Investigation: Equal), Edoardo Forti, MD (Data curation: Equal; Investigation: Equal), Laurent Palazzo, MD (Data curation: Equal; Investigation: Equal), Arthur Belle, MD (Data curation: Equal; Investigation: Equal), Peter Vilmann, MD (Investigation: Equal; Writing – review & editing: Supporting), Jean-Luc van Laethem, MD (Data curation: Equal; Investigation: Equal), Mehdi Mohamadnejad, MD (Data curation: Equal; Investigation: Equal), Godat Sebastien, MD (Data curation: Equal; Investigation: Equal), Pieter Hindryckx, MD (Data curation: Equal; Investigation: Equal), Ariel Benson, MD (Data curation: Equal; Investigation: Equal), Matteo Tacelli, MD (Data curation: Equal; Investigation: Equal), Germana De Nucci, MD (Data curation: Equal; Investigation: Equal), Cecilia Binda, MD (Data curation: Equal; Investigation: Equal), Bojan Kovacevic, MD (Data curation: Equal; Investigation: Equal; Writing – review & editing: Supporting), Harold Jacob, MD (Data curation: Supporting; Investigation: Supporting), Stefano Partelli, MD, PhD (Data curation: Equal; Investigation: Equal; Writing – review & editing: Equal), Massimo Falconi, MD, PhD (Investigation: Equal; Writing – review & editing: Equal), Roberto Salvia, MD, PhD (Investigation: Equal), Luca Landoni, MD (Data curation: Equal; Investigation: Equal; Writing – review & editing: Supporting), The ERASING Study Collaborators (Data curation: Supporting; Investigation: Supporting), Alberto Larghi, MD, PhD (Conceptualization: Supporting; Investigation: Equal; Writing – original draft: Equal; Writing – review & editing: Equal)
Publisher Copyright:
© 2023 AGA Institute
ID: 363064996