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Aggressive pancreatic resection for primary pancreatic neuroendocrine tumor: is it justifiable?
Am J Surg. 2007 May; 193(5):610-3; discussion 613.AJ

Abstract

BACKGROUND

Benign and malignant pancreatic neuroendocrine tumors (PNETs) are rare, and long-term outcome is generally poor without surgical intervention. The aim of the study was to assess whether aggressive pancreatic resection is justifiable for patients with PNET.

METHODS

All consecutive patients who had undergone major pancreatic resection from January 1997 through January 2005 were reviewed and analyzed.

RESULTS

There were 33 patients (16 male and 17 female) with a mean age of 53 years. Five patients had multiple endocrine neoplasms syndrome, and 1 patient had von Hippel-Lindau syndrome. There were 20 benign (9 functional) and 13 malignant (6 functional) neoplasms. Mean tumor size was 4.2 cm, and multiple tumors were noted in 10 patients. Eight patients (25%) underwent pancreticoduedenectomy, and 25 patients (76%) underwent distal pancreatectomy (extended distal pancreatectomy in 4 and splenectomy in 20 patients). Regional lymph node involvement was present in 10 patients (30%), and 6 patients (18%) had liver metastasis. Four patients (12%) underwent concurrent resection of other organs because of disease extension. Median intraoperative blood loss was 500 mL. Perioperative morbidity was 36%, and mortality was 3%. Symptomatic palliation was complete in 93% (14.15 patients) and partial in 1 patient because of nonresectable hepatic disease. Median hospital stay was 11.5 days. After median follow-up of 36 months, there were no local recurrences. The 1-, 3-, and 5-year overall survival rates for patients with benign versus malignant neoplasms were 100% vs. 92%, 89% vs. 64%, and 89% vs 36% (P = .01), respectively. The 1-, 3-, and 5-year disease progression rates for patients with malignant neoplasms were 13%, 63%, and 100%, respectively (P < .0001).

CONCLUSIONS

Aggressive pancreatic resection for PNET can be performed with low perioperative mortality and morbidity. Unlike available nonoperative therapy, this approach offers an excellent means of symptomatic palliation and local disease control. In patients with malignant PNET, metastatic recurrence is not uncommon and will usually require additional multimodality therapy. When possible, an aggressive approach to PNET is justified to optimize palliation and survival.

Authors+Show Affiliations

Department of Surgery, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR 97239, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17434366

Citation

Teh, Swee H., et al. "Aggressive Pancreatic Resection for Primary Pancreatic Neuroendocrine Tumor: Is It Justifiable?" American Journal of Surgery, vol. 193, no. 5, 2007, pp. 610-3; discussion 613.
Teh SH, Deveney C, Sheppard BC. Aggressive pancreatic resection for primary pancreatic neuroendocrine tumor: is it justifiable? Am J Surg. 2007;193(5):610-3; discussion 613.
Teh, S. H., Deveney, C., & Sheppard, B. C. (2007). Aggressive pancreatic resection for primary pancreatic neuroendocrine tumor: is it justifiable? American Journal of Surgery, 193(5), 610-3; discussion 613.
Teh SH, Deveney C, Sheppard BC. Aggressive Pancreatic Resection for Primary Pancreatic Neuroendocrine Tumor: Is It Justifiable. Am J Surg. 2007;193(5):610-3; discussion 613. PubMed PMID: 17434366.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Aggressive pancreatic resection for primary pancreatic neuroendocrine tumor: is it justifiable? AU - Teh,Swee H, AU - Deveney,Clifford, AU - Sheppard,Brett C, PY - 2006/12/06/received PY - 2007/01/29/revised PY - 2007/01/29/accepted PY - 2007/4/17/pubmed PY - 2007/5/4/medline PY - 2007/4/17/entrez SP - 610-3; discussion 613 JF - American journal of surgery JO - Am J Surg VL - 193 IS - 5 N2 - BACKGROUND: Benign and malignant pancreatic neuroendocrine tumors (PNETs) are rare, and long-term outcome is generally poor without surgical intervention. The aim of the study was to assess whether aggressive pancreatic resection is justifiable for patients with PNET. METHODS: All consecutive patients who had undergone major pancreatic resection from January 1997 through January 2005 were reviewed and analyzed. RESULTS: There were 33 patients (16 male and 17 female) with a mean age of 53 years. Five patients had multiple endocrine neoplasms syndrome, and 1 patient had von Hippel-Lindau syndrome. There were 20 benign (9 functional) and 13 malignant (6 functional) neoplasms. Mean tumor size was 4.2 cm, and multiple tumors were noted in 10 patients. Eight patients (25%) underwent pancreticoduedenectomy, and 25 patients (76%) underwent distal pancreatectomy (extended distal pancreatectomy in 4 and splenectomy in 20 patients). Regional lymph node involvement was present in 10 patients (30%), and 6 patients (18%) had liver metastasis. Four patients (12%) underwent concurrent resection of other organs because of disease extension. Median intraoperative blood loss was 500 mL. Perioperative morbidity was 36%, and mortality was 3%. Symptomatic palliation was complete in 93% (14.15 patients) and partial in 1 patient because of nonresectable hepatic disease. Median hospital stay was 11.5 days. After median follow-up of 36 months, there were no local recurrences. The 1-, 3-, and 5-year overall survival rates for patients with benign versus malignant neoplasms were 100% vs. 92%, 89% vs. 64%, and 89% vs 36% (P = .01), respectively. The 1-, 3-, and 5-year disease progression rates for patients with malignant neoplasms were 13%, 63%, and 100%, respectively (P < .0001). CONCLUSIONS: Aggressive pancreatic resection for PNET can be performed with low perioperative mortality and morbidity. Unlike available nonoperative therapy, this approach offers an excellent means of symptomatic palliation and local disease control. In patients with malignant PNET, metastatic recurrence is not uncommon and will usually require additional multimodality therapy. When possible, an aggressive approach to PNET is justified to optimize palliation and survival. SN - 1879-1883 UR - https://www.unboundmedicine.com/medline/citation/17434366/Aggressive_pancreatic_resection_for_primary_pancreatic_neuroendocrine_tumor:_is_it_justifiable L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9610(07)00093-1 DB - PRIME DP - Unbound Medicine ER -