title: Efficacy and cost-effectiveness of immediate surgery versus a wait-and-see strategy for sporadic nonfunctioning T1 pancreatic endocrine neoplasms.
abstract: BACKGROUND
  Whether patients with small (<2 cm), sporadic nonfunctioning pancreatic endocrine tumors (NF-PETs) should directly undergo pancreatic surgery or should be followed longitudinally to detect growth and malignancy still has to be defined.
  
  
  METHODS
  Based on the pertinent literature of the past decade, a Markov model was developed to investigate this issue. In the wait-and-see strategy arm, surgery was performed if the tumor attained a size ≥2 cm or surpassed 20% of the initial size. In a Monte Carlo probabilistic analysis, 100 hypothetical patients undergoing a wait-and-see strategy were compared to 100 patients directly undergoing surgery, with the aim of investigating the efficacy and cost-effectiveness of the two strategies.
  
  
  RESULTS
  During the postdiagnostic lifetime, 63 NF-PETs in the wait-and-see group showed significant growth and underwent surgery: 38 were stage I, 10 were stage II, 15 were stage III and none were stage IV. In the base-case scenario, the mean life expectancy and quality-adjusted life expectancy were found to be superior after immediate surgery [26.1 years and 11.8 quality-adjusted life years (QALYs)] than with the wait-and-see strategy (22.1 years and 8.3 QALYs) as the consequence of ageing during the wait-and-see follow-up which increased mortality due to surgery, when surgery was needed. The model was sensitive to starting age and length of follow-up; in particular, for patients >65 years of age, the two strategies provided similar results but the wait-and-see strategy was more cost-effective.
  
  
  CONCLUSIONS
  The wait-and-see strategy for NF-PETs <2 cm represents a reasonable approach in patients over 65 years of age; otherwise, immediate surgery is preferable.
authors.affiliation: Department of Medical and Surgical Sciences - DIMEC, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cucchetti
authors.forename: Claudio
authors.initials: C
authors.lastname: Ricci
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.forename: Davide
authors.initials: D
authors.lastname: Campana
authors.forename: Matteo
authors.initials: M
authors.lastname: Cescon
authors.forename: Marielda
authors.initials: M
authors.lastname: D'Ambra
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
authors.forename: Francesco
authors.initials: F
authors.lastname: Minni
authors.forename: Riccardo
authors.initials: R
authors.lastname: Casadei
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000191:economics* / Q000601:surgery*; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D055815:Young Adult