One-Year Postoperative Mortality in MEN1 Patients Operated on Gastric and Duodenopancreatic Neuroendocrine Tumors: An AFCE and GTE Cohort Study

• Published in: World journal of surgery Vol. 43; no. 11; pp. 2856 - 2864
• Main Authors: Christou, Niki, Mathonnet, Muriel, Gaujoux, Sébastien, Cadiot, Guillaume, Deguelte, Sophie, Kraimps, Jean-Louis, Lifante, Jean-Christophe, Menegaux, Fabrice, Mirallié, Eric, Muscari, Fabrice, Carnaille, Bruno, Pattou, François, Sauvanet, Alain, Goudet, Pierre
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.11.2019; Springer Nature B.V
• Subjects: Abdominal Surgery; Cardiac Surgery; Cohort analysis; Complications; Death; Fatalities; General Surgery; Guanosine diphosphate; Lesions; Medicine; Medicine & Public Health; Metastases; Metastasis; Mortality; Neuroendocrine tumors; Original Scientific Report; Patients; Postoperative period; Secretions; Surgery; Thoracic Surgery; Tumors; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-019-05107-7

Importance In MEN1 patients with gastric and duodenopancreatic neuroendocrine tumors (GPD-NET), surgery aims to control secretions or to prevent metastatic spread, but after GPD-NET resection, postoperative mortality may be related to the surgery itself or to other associated MEN1 lesions with their own uncontrolled secretions or metastatic behavior. Objective To analyze the causes of death within 1 year following a GPD-NET resection in MEN1 patients. Design An observational study collecting data from the Groupe d’étude des Tumeurs Endocrines (GTE) database. The analysis considered the time between surgery and death (early deaths [<1 month after surgery] versus delayed deaths [beyond 1 month after surgery]) and the period (before 1990 vs after 1990). Causes of death were classified as related to GDP surgery, related to surgery for other MEN1 lesions or not related to MEN1 causes. Setting GTE database which includes 1220 MEN1 patients and 441 GPD-NET resections. Participants Four hundred and forty-one GPD-NET resections. Main outcome measures The primary end point was postoperative mortality within 1 year after surgery. Results Twenty-four patients met the inclusion criteria (2%). Median age at death was 50.5 years. Sixteen deaths occurred in the 30-day postoperative period (76%). Among the 8 delayed deaths, 3 occurred as a result of medical complications between 30 and 90 postoperative days. After 1990, mean age at death increased from 48 to 58 years ( p  = 0.09), deaths related to uncontrolled acid secretion disappeared ( p  < 0.001) and deaths related to associated MEN1 lesions increased from 8 to 54% ( p  = 0.16). Conclusion Surgery and uncontrolled secretions remain the two main causes of death in MEN1 patients operated for a GPD-NET tumor. Improving the prognosis of these patients requires a strict evaluation of the secretory syndrome and MEN1 aggressiveness before GDP surgery.