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Comparison of EUS-guided ablation and surgical resection for non-functioning small pancreatic neuroendocrine tumors: a propensity score matching study

  • Author Footnotes
    ∗ These authors equally contributed to the study as co-first authors.
    Hoonsub So
    Footnotes
    ∗ These authors equally contributed to the study as co-first authors.
    Affiliations
    Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
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  • Author Footnotes
    ∗ These authors equally contributed to the study as co-first authors.
    Sung Woo Ko
    Footnotes
    ∗ These authors equally contributed to the study as co-first authors.
    Affiliations
    Department of Internal Medicine, The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Seoul, South Korea
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  • Seung Hwan Shin
    Affiliations
    Division of Gastroenterology, Department of Internal Medicine, Asan medical center, University of Ulsan College of Medicine, Seoul, South Korea
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  • Eun Ha Kim
    Affiliations
    Division of Gastroenterology, Department of Internal Medicine, Asan medical center, University of Ulsan College of Medicine, Seoul, South Korea
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  • Jimin Son
    Affiliations
    Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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  • SuHyun Ha
    Affiliations
    Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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  • Ki Byung Song
    Affiliations
    Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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  • Hwa Jung Kim
    Affiliations
    Department of Clinical Epidemiology and Biostatistics, Department of Preventive Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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  • Myung-Hwan Kim
    Affiliations
    Division of Gastroenterology, Department of Internal Medicine, Asan medical center, University of Ulsan College of Medicine, Seoul, South Korea
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  • Do Hyun Park
    Correspondence
    Corresponding author Do Hyun Park, M.D., Ph.D. Digestive Diseases Research Center, Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel.: +82-2-3010-3194 Fax: +82-2-476-0824
    Affiliations
    Division of Gastroenterology, Department of Internal Medicine, Asan medical center, University of Ulsan College of Medicine, Seoul, South Korea
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  • Author Footnotes
    ∗ These authors equally contributed to the study as co-first authors.
Open AccessPublished:November 15, 2022DOI:https://doi.org/10.1016/j.gie.2022.11.004
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      Abstract

      Background and Aims

      Treatment strategies for small pancreatic neuroendocrine tumors (PNETs) < 2 cm in size are still under debate. The feasibility and safety of endoscopic ultrasound (EUS)-guided ethanol ablation (EUS-EA) have been demonstrated. However, the sample size in previous studies was small with no comparative studies on surgery. Therefore, we aimed to compare the safety and long-term outcomes of EUS-EA using ethanol with those of surgery for the management of non-functioning small PNETs.

      Methods

      We retrospectively reviewed patients with a PNET who were managed by EUS-EA (from 2011 to 2018) and surgery (from 2000 to 2018) at Asan Medical Center. Propensity score matching (PSM) was performed to increase the comparability. The primary outcome was early and late major complications (Clavien–Dindo grade 3 or more) after treatment. The secondary outcomes were 10-year overall and disease-specific survival rates, length of hospital stay, and development of endocrine pancreatic insufficiency.

      Results

      A total of 97 and 188 patients were included in the EUS-EA and surgery groups, respectively. PSM created 89 matched pairs. EUS-EA was associated with a significantly lower rate of early major complications (0% vs. 11.2%; P=0.003). Late major complications occurred more frequently after surgery, with no significant difference between the groups (3.4% vs. 10.1%, P=0.07). Both treatment modalities showed comparable 10-year overall and disease-specific survival rates. The length of hospital stay was significantly shorter in the EUS-EA group (4 days vs. 14.1 days, P<0.001), and endocrine pancreatic insufficiency was less common after EUS-EA than after surgery (33.3% vs. 48.6%, P=0.121).

      Conclusions

      EUS-EA had fewer complications and a shorter hospital stay with similar overall and disease-specific survival rates compared to surgery, suggesting that EUS-EA may be a preferred alternative to surgical resection in selected patients with a non-functioning small PNET.

      Graphical abstract

      Keywords