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Surgery for Pancreatic Neuroendocrine Tumor G3 and Carcinoma G3 Should be Considered Separately

Tsukasa Yoshida MD, Susumu Hijioka MD, PhD, Waki Hosoda MD, PhD, Makoto Ueno MD, Masayuki Furukawa MD, PhD, Noritoshi Kobayashi MD, PhD, Masafumi Ikeda MD, Tetsuhide Ito MD, PhD, Yuzo Kodama MD, PhD, Chigusa Morizane MD, PhD, Kenji Notohara MD, PhD, Hiroki Taguchi MD, PhD, Masayuki Kitano MD, PhD, Kei Yane MD, Yoshiaki Tsuchiya MD, Izumi Komoto MD, PhD, Hiroki Tanaka MD, Akihito Tsuji MD, PhD, Syu
Endocrine Tumors
Volume 26, Issue 5 / May , 2019



The role of surgery in pancreatic neuroendocrine neoplasm grade 3 (pNEN-G3) treatment remains unclear. We aimed to clarify the role of surgery for pNEN-G3, which has recently been reclassified as pancreatic neuroendocrine tumor-G3 (pNET-G3) and pancreatic neuroendocrine carcinoma-G3 (pNEC-G3), with and without metastases, respectively.


We analyzed a subgroup of patients from the Japanese pancreatic NEC study, a Japanese multicenter case-series study of pNEN-G3. Pathologists subclassified 67 patients as having pNET-G3 or pNEC-G3 based on morphological features. We compared the overall survival (OS) rates among patients who were grouped according to whether they had undergone tumor-targeted surgery for tumors without (SwoM) or with (SwM) metastases, or non-surgical procedures (NS).


Data from 21 patients with pNET-G3 (SwoM, n = 6; SwM, n = 5; NS, n = 10) and 46 patients with pNEC-G3 (SwoM, n = 8; SwM, n = 5; NS, n = 33) were analyzed. OS of patients with pNET-G3 was significantly longer after SwoM and SwM than with NS (p = 0.018 and p = 0.022). In contrast, OS did not significantly differ between either SwoM or SwM and NS (p = 0.093 and p = 0.489) among patients with pNEC-G3.


The role of surgery should be considered separately for pNET-G3 and pNEC-G3. Although SwoM and SwM can be considered for pNET-G3, caution is advised before considering SwM and SwoM for pNEC-G3.

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