Clinical Scorecard: Management of Pancreatic Neuroendocrine Tumors through Surgery Amidst the COVID-19 Pandemic: Insights from a High-Volume Center's Retrospective Cohort Study
Delayed diagnosis and surgery due to COVID-19 resource reallocation; increased preoperative oncological 'bridge' therapies; prioritization of malignant conditions over borderline-malignant tumors
Target Population
Patients with NF-PNETs requiring surgical management
Care Setting
High-volume pancreatic surgery center during COVID-19 pandemic
Key Highlights
Surgical waiting times for NF-PNETs nearly doubled during the COVID-19 pandemic (median 182 to 382 days).
Increased use of preoperative oncological treatments (PRRT, somatostatin analogs, chemotherapy) as bridge therapy during the pandemic.
Despite delays, major postoperative complications decreased during the COVID-19 period (24% to 13%).
Guideline-Based Recommendations
Diagnosis
Use cross-sectional imaging (preferably MRI) and biopsy (fine-needle aspiration or biopsy) for diagnosis confirmation and Ki67 assessment.
Employ 68Gallium DOTA-PET/CT routinely; selectively use 18FDG PET/CT.
Conduct multidisciplinary tumor board evaluations for treatment planning.
Management
Prioritize surgery for NF-PNETs larger than 20 mm to improve prognosis and prevent recurrence.
During resource constraints, prioritize malignant conditions and those treated with neoadjuvant therapy.
Consider preoperative oncological 'bridge' therapies (PRRT, SSA, chemotherapy) when surgery is delayed.
Monitoring & Follow-up
Monitor tumor size, vascular infiltration, and lymphadenopathy via imaging.
Assess tumor grading and Ki67 proliferation index pre- and postoperatively.
Track waiting times from diagnosis to surgery to mitigate delays.
Risks
Delays in surgery may increase risk of tumor progression and lymphatic infiltration.
Resource reallocation during pandemics can cause postponed surgeries and disrupted surveillance.
Ethical concerns arise in patient prioritization when resources are scarce.
Patient & Prescribing Data
Patients with NF-PNETs undergoing surgical evaluation during the COVID-19 pandemic.
Increased use of preoperative oncological therapies as bridge treatments was observed during the pandemic to manage surgical delays.
Clinical Best Practices
Maintain multidisciplinary evaluation for individualized treatment decisions.
Use bridge therapies to manage patients when surgical delays are unavoidable.
Prioritize malignant and high-risk tumors for surgery during resource-limited periods.
Monitor tumor progression closely during extended waiting times.
by Salvatore Paiella, Luca Landoni, Matteo De Pastena, Giovanni Elio, Fabio Casciani, Sara Cingarlini, Mirko D’Onofrio, Giulia Maistri, Ivan Ciatti, Massimiliano Tuveri, Maria Vittoria Davì, Claudio Luchini, Katia Donadello, Gessica Manzini, Giuseppe Malleo, Roberto Salvia
