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Endoscopic Ultrasound-Guided Radiofrequency Ablation Versus Surgical Resection for Treatment of Pancreatic Insulinoma Publisher Pubmed



Crino SF1 ; Napoleon B2 ; Facciorusso A3 ; Lakhtakia S4 ; Borbath I5 ; Caillol F6 ; Docong Pham K7 ; Rizzatti G8 ; Forti E9 ; Palazzo L10 ; Belle A11 ; Vilmann P12 ; Van Laethem JL13 ; Mohamadnejad M14 Show All Authors
Authors
  1. Crino SF1
  2. Napoleon B2
  3. Facciorusso A3
  4. Lakhtakia S4
  5. Borbath I5
  6. Caillol F6
  7. Docong Pham K7
  8. Rizzatti G8
  9. Forti E9
  10. Palazzo L10
  11. Belle A11
  12. Vilmann P12
  13. Van Laethem JL13
  14. Mohamadnejad M14
  15. Godat S15
  16. Hindryckx P16
  17. Benson A17
  18. Tacelli M18
  19. De Nucci G19
  20. Binda C20
  21. Kovacevic B12
  22. Jacob H17
  23. Partelli S21
  24. Falconi M21
  25. Salvia R22
  26. Landoni L22
  27. Alfieri S23
  28. Arcidiacono PG18
  29. Arvanitakis M24
  30. Battistella A21
  31. Bernadroni L1
  32. Brink L12
  33. Cintolo M9
  34. Conti Bellocchi MC1
  35. Davi MV25
  36. Deguelte S26
  37. Deprez P5
  38. Deviere J24
  39. Ewald J27
  40. Fabbri C20
  41. Ferrari G28
  42. Furnica RM29
  43. Gabbrielli A1
  44. Garcesduran R25
  45. Giovannini M6
  46. Gonda T30
  47. Gornals JB31
  48. Marx M15
  49. Mazzola M28
  50. Mutignani M9
  51. Ofosu A32
  52. Pereira SP33
  53. Perrier M26
  54. Przybylkowski A34
  55. Repici A35
  56. Sundaram S36
  57. Tripodi G7
  58. Larghi A7
Show Affiliations
Authors Affiliations
  1. 1. Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy
  2. 2. Service de Gastroenterologie, Hopital Prive Jean Mermoz, Ramsay Generale de Sante, Lyon, France
  3. 3. Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
  4. 4. Asian Institute of Gastroenterology, Hyderabad, India
  5. 5. Department of Hepato-gastroenterology, Cliniques Universitaires St Luc, Brussels, Belgium
  6. 6. Endoscopy Unit, Paoli Calmettes Institute, Marseille, France
  7. 7. Department of Medicine, Haukeland University Hospital, Bergen, Norway
  8. 8. Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
  9. 9. Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan, Italy
  10. 10. Department of Endoscopy, Trocadero Clinic, Paris, France
  11. 11. Department of Gastroenterology, Cochin Hospital, Paris, France
  12. 12. Department of Gastroenterology, Herlev-Gentofte Hospital, Herlev, Denmark
  13. 13. Hepato-Gastroenterology, Hopital Erasme, Universite Libre de Bruxelles (ULB), Brussels, Belgium
  14. 14. Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
  15. 15. Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
  16. 16. Department of Gastroenterology, University of Ghent, Ghent, Belgium
  17. 17. Institute of Gastroenterology and Hepatology, Hadassah Medical Center, Jerusalem, Israel and Faculty of Medicine, Hebrew University of, Jerusalem, Israel
  18. 18. Pancreato-biliary Endoscopy and EUS Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
  19. 19. Gastroenterology and Endoscopy Unit, ASST Rhodense, Garbagnate Milanese, Milan, Italy
  20. 20. Gastroenterology and Digestive Endoscopy Unit, Ospedale Morgagni-Pierantoni, AUSL Romagna, Forli, Italy
  21. 21. Pancreatic and Transplant Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele IRCCS, Universita Vita-Salute, Milan, Italy
  22. 22. General and Pancreatic Surgery Department, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
  23. 23. Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
  24. 24. Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, HUB Erasme Hospital, Universite Libre de Bruxelles, Brussels, Belgium
  25. 25. Department of Medicine, Section of Endocrinology, University and Hospital Trust of Verona, Verona, Italy
  26. 26. Reims-Champagne-Ardennes University, Department of General and Digestive Surgery, Robert-Debre Hospital, Reims, France
  27. 27. Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
  28. 28. Division of Oncologic and Mini-Invasive General Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
  29. 29. Department of Endocrinology and Nutrition, Universite Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
  30. 30. Department of Medicine, New York University Langone Health, New York, NY, United States
  31. 31. Digestive Diseases/Endoscopy, Hospital Universitari de Bellvitge/Universitat de Barcelona, Barcelona, Spain
  32. 32. Division of Gastroenterology and Hepatology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
  33. 33. Department of Gastroenterology, University College Hospitals NHS Foundation Trust, London, United Kingdom
  34. 34. Department of Gastroenterology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
  35. 35. Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Milan, Italy
  36. 36. Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, India

Source: Clinical Gastroenterology and Hepatology Published:2023


Abstract

Background & Aims: 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. © 2023 AGA Institute