Evaluating the ACS-NSQIP risk calculator in primary pancreatic neuroendocrine tumor: results from the united states neuroendocrine tumor study group

The ACS established an online risk calculator to help surgeons make patient-specific estimates of postoperative morbidity and mortality. Our objective was to assess the accuracy of the ACS-NSQIP calculator for estimating risk after curative intent resection for primary GI neuroendocrine tumors (GI-NETs). Adult patients with GI-NET who underwent complete resection from 2000 to 2017 were identified using a multi-institutional database, including data from eight academic medical centers. The ability of the NSQIP calculator to accurately predict a particular outcome was assessed using receiver operating characteristic curves and the area under the curve (AUC). Seven hundred three patients were identified who met inclusion criteria. The most commonly performed procedures were resection of the small intestine with anastomosis (N = 193, 26%) and partial colectomy with anastomosis (N = 136, 18%). The majority of patients were younger than 65 years (N = 482, 37%) and ASA Class III (N = 337, 48%). The most common comorbidities were diabetes (N = 128, 18%) and hypertension (N = 395, 56%). Complications among these patients based on ACS NSQIP definitions included any complication (N = 132, 19%), serious complication (N = 118, 17%), pneumonia (N = 7, 1.0%), cardiac complication (N = 1, 0.01%), SSI (N = 80, 11.4%), UTI (N = 17, 2.4%), venous thromboembolism (N = 18, 2.5%), renal failure (N = 16, 2.3%), return to the operating room (N = 27, 3.8%), discharge to nursing/rehabilitation (N = 22, 3.1%), and 30-day mortality (N = 9, 1.3%). The calculator provided reasonable estimates of risk for pneumonia (AUC = 0.721), cardiac complication (AUC = 0.773), UTI (AUC = 0.716), and discharge to nursing/ rehabilitation (AUC = 0.779) and performed poorly (AUC < 0.7) for all other complications Fig. 1). The ACS-NSQIP risk calculator estimates a similar proportion of risk to actual events in patients with GI-NET but has low specificity for identifying the correct patients for many types of complications. The risk calculator may require modification for some patient populations.

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The impact of failure to achieve symptom control after resection of functional neuroendocrine tumors: An 8-institution study from the US Neuroendocrine Tumor Study Group

HPB ◽

10.1016/j.hpb.2018.06.053 ◽

2018 ◽

Vol 20 ◽

pp. S195-S196

Author(s):

M. Zaidi ◽

A. Lopez-Aguiar ◽

G. Poultsides ◽

M. Dillhoff ◽

F. Rocha ◽

...

Keyword(s):

Neuroendocrine Tumor ◽

Neuroendocrine Tumors ◽

Symptom Control ◽

Study Group ◽

Tumor Study ◽

The Us ◽

The Impact ◽

Tumor Study Group

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Minimally Invasive versus Open Distal Pancreatectomy for Pancreatic Neuroendocrine Tumors: An Analysis from the U.S. Neuroendocrine Tumor Study Group

HPB ◽

10.1016/j.hpb.2019.10.1569 ◽

2019 ◽

Vol 21 ◽

pp. S203

Author(s):

Xu-Feng Zhang ◽

Yi Lv ◽

Timothy Pawlik

Keyword(s):

Minimally Invasive ◽

Neuroendocrine Tumor ◽

Distal Pancreatectomy ◽

Neuroendocrine Tumors ◽

Study Group ◽

Pancreatic Neuroendocrine Tumors ◽

Tumor Study ◽

Open Distal Pancreatectomy ◽

The U.S ◽

Tumor Study Group

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Defining the number of lymph nodes needed to accurately stage small bowel neuroendocrine tumors: An 8-institution study from the US neuroendocrine tumor study group.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.265 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 265-265

Author(s):

Mohammad Zaidi ◽

Alexandra G Lopez-Aguiar ◽

Mary Dillhoff ◽

Eliza W Beal ◽

George A. Poultsides ◽

...

Keyword(s):

Small Bowel ◽

Lymph Nodes ◽

Neuroendocrine Tumor ◽

Neuroendocrine Tumors ◽

Lymph Node Staging ◽

Study Group ◽

Curative Intent ◽

Tumor Study ◽

The Us ◽

Tumor Study Group

265 Background: Small bowel neuroendocrine tumors (SB-NETs) frequently involve regional lymph nodes (LNs). The prognostic value of LN positivity on recurrence of disease is not well defined. The number of LNs needed to accurately stage patients is unknown. Methods: All patients with primary SB-NETs who underwent curative-intent resection at 8 institutions in the US Neuroendocrine Tumor Study Group between 2000 and 2016 were identified. Patients with distant metastatic disease were excluded. The association of LN positivity with recurrence of disease and the extent of lymphadenectomy required were analyzed. Results: Of 2182 patients with resected NETs, 203 had SB-NETs. Median age was 60 yrs, 56% were male, and median follow-up was 39 months. 83.5% of patients (n = 157) had LN positive disease. There was no difference in 3-year recurrence free survival (3-yr RFS) among patients with 1 or 2 positive LNs compared to patients with negative LNs (p = 0.63). Patients who had 3 or more positive LNs had a worse 3-yr RFS compared to those with 0, 1, or 2 positive LNs (n = 92 vs n = 73; 3-yr RFS 82% vs 92%; p < 0.001). Retrieval of 8 or more LNs was associated with a higher positive LN count compared to less than 8 LNs (4.6 vs. 1.6; p = 0.002). However, an increasing LN ratio was not associated with 3-yr RFS. When examining patients who had less than 8 lymph nodes retrieved, there was no difference in 3-yr RFS in those patients with 3 or more positive LNs compared to those with 0, 1, or 2 positive LNs (3-yr RFS: 100% vs 91%; p = 0.37). Retrieval of more than 8 lymph nodes, however, accurately discriminated patients with 3 or more positive LNs compared to those with 0, 1, or 2 positive LNs (3-yr RFS: 79.7% vs 93.5%; p = 0.005). Conclusions: For patients undergoing curative-intent resection of small bowel NETs, accurate lymph node staging requires a minimum of 8 lymph nodes for examination. 3 or more positive LNs is associated with decreased 3-yr RFS compared to 0, 1, or 2 positive lymph nodes. A thorough regional lymphadenectomy is critical for accurate staging and management of patients with small bowel neuroendocrine tumors.

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