Ultrasound guided radiofrequency ablation safer than surgery against pancreatic insulinoma

For the treatment of pancreatic insulinoma (PI), Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is both safer and more successful than surgery, says an article published in Clinical Gastroenterology and Hepatology. 

Pancreatic neuroendocrine tumors are increasingly being treated safely and successfully with endoscopic ultrasound-guided radiofrequency ablation. In order to compare EUS-RFA with surgical excision for the treatment of pancreatic insulinoma, Stefano Francesco Crin and colleagues did this study.

Propensity-matching analysis was used to assess the results of patients with sporadic PI who had EUS-RFA at 23 sites or surgical resection at eight high-volume pancreatic surgery institutes between 2014 and 2022. The main result was safety. Clinical effectiveness, length of hospital stay, and recurrence rate following EUS-RFA were secondary outcomes.

The key findings of this study were:

89 patients were divided equally among the two groups (1:1) using propensity score matching. 

They were equally distributed in terms of sex, age, Charlson comorbidity index, BMI, ASA score, distance from major pancreatic duct, location, size, and grade of lesion. 

After surgery and EUS-RFA, respectively, the rates of adverse events (AEs) were 18.0% and 61.8% (P 0.001). 

In contrast to the 7.8% of serious AEs that occurred after surgery, there were none in the EUS-RFA group (P=0.0002). 

After surgery, clinical effectiveness was 100%, and after EUS-RFA, it was 95.5% (P=0.160). 

The average follow-up period was, however, shorter in the EUS-RFA group. The surgical group's length of hospital stay was much greater. 

After an EUS-RFA, fifteen (16.9%) lesions returned, and they were successfully treated with a second EUS-RFA (on 11 patients) or surgical removal (4 pts).

In conclusion, nonetheless, recurrence rates are greater with EUS-RFA than with surgical resection, despite the fact that it is safer and more effective than surgery for the treatment of PI.

Reference:

Crinò, S. F., Napoleon, B., Facciorusso, A., Lakhtakia, S., Borbath, I., Caillol, F., Do-Cong Pham, K., Rizzatti, G., Forti, E., Palazzo, L., Belle, A., Vilmann, P., van Laethem, J.-L., Mohamadnejad, M., Godat, S., Hindryckx, P., Benson, A., Tacelli, M., De Nucci, G., … Tripodi, G. (2023). ENDOSCOPIC ULTRASOUND-GUIDED RADIOFREQUENCY ABLATION VERSUS SURGICAL RESECTION FOR TREATMENT OF PANCREATIC INSULINOMA. In Clinical Gastroenterology and Hepatology. Elsevier BV. https://doi.org/10.1016/j.cgh.2023.02.022