Endoscopic Ultrasound-guided Radiofrequency Ablation Versus Surgical Resection for Treatment of Pancreatic Insulinoma

Stefano Francesco Crinò; Bertrand Napoleon; Antonio Facciorusso; Sundeep Lakhtakia; Ivan Borbath; Fabrice Caillol; Khanh Do-Cong Pham; Gianenrico Rizzatti; Edoardo Forti; Laurent Palazzo; Arthur Belle; Peter Vilmann; Jean-Luc van Laethem; Mehdi Mohamadnejad; Sebastien Godat; Pieter Hindryckx; Ariel Benson; Matteo Tacelli; Germana De Nucci; Cecilia Binda; Bojan Kovacevic; Harold Jacob; Stefano Partelli; Massimo Falconi; Roberto Salvia; Luca Landoni; ERASING study collaborators; Alberto Larghi

doi:10.1016/j.cgh.2023.02.022

Endoscopic Ultrasound-guided Radiofrequency Ablation Versus Surgical Resection for Treatment of Pancreatic Insulinoma

Clin Gastroenterol Hepatol. 2023 Oct;21(11):2834-2843.e2. doi: 10.1016/j.cgh.2023.02.022. Epub 2023 Mar 4.

Authors

Stefano Francesco Crinò¹, Bertrand Napoleon², Antonio Facciorusso³, Sundeep Lakhtakia⁴, Ivan Borbath⁵, Fabrice Caillol⁶, Khanh Do-Cong Pham⁷, Gianenrico Rizzatti⁸, Edoardo Forti⁹, Laurent Palazzo¹⁰, Arthur Belle¹¹, Peter Vilmann¹², Jean-Luc van Laethem¹³, Mehdi Mohamadnejad¹⁴, Sebastien Godat¹⁵, Pieter Hindryckx¹⁶, Ariel Benson¹⁷, Matteo Tacelli¹⁸, Germana De Nucci¹⁹, Cecilia Binda²⁰, Bojan Kovacevic¹², Harold Jacob¹⁷, Stefano Partelli²¹, Massimo Falconi²¹, Roberto Salvia²², Luca Landoni²²; ERASING study collaborators; Alberto Larghi⁷

Collaborators

ERASING study collaborators:
Sergio Alfieri²³, Paolo Giorgio Arcidiacono¹⁸, Marianna Arvanitakis²⁴, Anna Battistella²¹, Laura Bernadroni²⁵, Lene Brink¹², Marcello Cintolo⁹, Maria Cristina Conti Bellocchi²⁵, Maria Vittoria Davì²⁶, Sophie Deguelte²⁷, Pierre Deprez⁵, Jaques Deviere²⁴, Jacques Ewald²⁸, Carlo Fabbri²⁰, Giovanni Ferrari²⁹, Raluca Maria Furnica³⁰, Armando Gabbrielli²⁵, Rodrigo Garcés-Duran²⁶, Marc Giovannini⁶, Tamas Gonda³¹, Joan B Gornals³², Mariola Marx¹⁵, Michele Mazzola²⁹, Massimiliano Mutignani⁹, Andrew Ofosu³³, Stephan P Pereira³⁴, Marine Perrier²⁷, Adam Przybylkowski³⁵, Alessandro Repici³⁶, Sridhar Sundaram³⁷, Giulia Tripodi⁷

Affiliations

¹ Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy. Electronic address: stefanofrancesco.crino@aovr.veneto.it.
² Service de Gastroentérologie, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France.
³ Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
⁴ Asian Institute of Gastroenterology, Hyderabad, India.
⁵ Department of Hepato-gastroenterology, Cliniques Universitaires St Luc, Brussels, Belgium.
⁶ Endoscopy Unit, Paoli Calmettes Institute, Marseille, France.
⁷ Department of Medicine, Haukeland University Hospital, Bergen, Norway.
⁸ Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁹ Digestive and Interventional Endoscopy Unit, ASST Niguarda, Milan, Italy.
¹⁰ Department of Endoscopy, Trocadero Clinic, Paris, France.
¹¹ Department of Gastroenterology, Cochin Hospital, Paris, France.
¹² Department of Gastroenterology, Herlev-Gentofte Hospital, Herlev, Denmark.
¹³ Hepato-Gastroenterology, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.
¹⁴ Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.
¹⁵ Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
¹⁶ Department of Gastroenterology, University of Ghent, Ghent, Belgium.
¹⁷ Institute of Gastroenterology and Hepatology, Hadassah Medical Center, Jerusalem, Israel and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
¹⁸ Pancreato-biliary Endoscopy and EUS Division, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
¹⁹ Gastroenterology and Endoscopy Unit, ASST Rhodense, Garbagnate Milanese, Milan, Italy.
²⁰ Gastroenterology and Digestive Endoscopy Unit, Ospedale Morgagni-Pierantoni, AUSL Romagna, Forlì, Italy.
²¹ Pancreatic and Transplant Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele IRCCS, Università Vita-Salute, Milan, Italy.
²² General and Pancreatic Surgery Department, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
²³ Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
²⁴ Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, HUB Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
²⁵ Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy.
²⁶ Department of Medicine, Section of Endocrinology, University and Hospital Trust of Verona, Verona, Italy.
²⁷ Reims-Champagne-Ardennes University, Department of General and Digestive Surgery, Robert-Debré Hospital, Reims, France.
²⁸ Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France.
²⁹ Division of Oncologic and Mini-Invasive General Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
³⁰ Department of Endocrinology and Nutrition, Université Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium.
³¹ Department of Medicine, New York University Langone Health, New York, NY.
³² Digestive Diseases/Endoscopy, Hospital Universitari de Bellvitge/Universitat de Barcelona, Barcelona, Spain.
³³ Division of Gastroenterology and Hepatology, University of Cincinnati College of Medicine, Cincinnati, OH.
³⁴ Department of Gastroenterology, University College Hospitals NHS Foundation Trust, London, United Kingdom.
³⁵ Department of Gastroenterology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
³⁶ Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Milan, Italy.
³⁷ Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, India.

PMID: 36871765
DOI: 10.1016/j.cgh.2023.02.022

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.

Keywords: Acute pancreatitis; Hypoglycemia; Insulin; Neuroendocrine Tumor; Pancreatic Fistula.

MeSH terms

Catheter Ablation*
Humans
Insulinoma* / diagnostic imaging
Insulinoma* / surgery
Pancreatic Neoplasms* / diagnostic imaging
Pancreatic Neoplasms* / pathology
Pancreatic Neoplasms* / surgery
Radiofrequency Ablation*
Retrospective Studies
Treatment Outcome
Ultrasonography, Interventional