Management of the primary tumor in patients with metastatic pancreatic neuroendocrine tumor: a contemporary single-institution review

Bruzoni, Matías; Parikh, Purvi; Celis, Rolando; Are, Chandrakanth; Ly, Quan P.; Meza, Jane L.; Sasson, Aaron R.

doi:10.1016/j.amjsurg.2008.11.005

Cited by 24 publications

(13 citation statements)

References 19 publications

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“…The abstracts and/or full texts of 72 studies were examined in more detail, but 68 of them were further excluded, as – although dealing with endocrine tumours – they did not address the topic of the study. Of the 4 studies potentially appropriate to be included in the review [11,15,16,17], 3 were excluded because they did not contain sufficient data for the two treatment arms [11,16,17]. Two additional studies were found by hand searching/search of references of the identified papers [18,19], leaving 3 studies with usable information, by outcome, analysed in detail [15,18,19].…”

Section: Resultsmentioning

confidence: 99%

“…Some authors have proposed this aggressive strategy [11] but literature data are difficult to evaluate as they often refer to heterogeneous series both in terms of tumour features, such as primary site and associated syndrome (functioning and non-functioning), and of surgical strategy, as data on patients treated with debulking of the primary PNET only either in the presence of metastatic or locally advanced disease are often mixed with those of patients treated with both pancreatic and hepatic debulking.…”

Section: Introductionmentioning

confidence: 99%

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Role of Resection of the Primary Pancreatic Neuroendocrine Tumour Only in Patients with Unresectable Metastatic Liver Disease: A Systematic Review

et al. 2011

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Background: Surgery remains the only curative option for pancreatic neuroendocrine tumours (PNETs), but its indication is limited by metastatic disease in most patients. Indication for removing the primary lesion only in the setting of unresectable liver disease is controversial. The present systematic review aims at determining the potential bene- fits (survival, progression-free survival) or harms (morbidity, mortality) of surgical resection of the primary lesion only in patients with PNETs and unresectable metastases. Meth ods: Medline was queried for studies reporting the outcome of PNET patients with unresectable liver metastases whenever there was an explicit comparison between resection of the primary lesion only (‘active treatment’) and no resection (‘non-active treatment’). The primary outcome was survival; possible secondary outcomes were progression-free survival, treatment-related mortality and morbidity, and relief of symptoms. Results: Only 3 cohort studies found were eligible and analysed; no meta-analysis could be performed. The number of patients undergoing ‘active treatment’ varied from 16 to 20, with a percentage ranging from 17 to 39% of cohorts. Survival was longer in patients who received ‘active treatment’ in 2 studies, and the 5-year survival rate also seemed higher, without significant complications. Discussion: Available data suggest a possible benefit of resection of the primary lesion only in this setting. However, a bias towards a more aggressive surgical approach in patients with a better performance status or less advanced disease seems likely, and no conclusion can be drawn except for the need of randomised trials. We calculated that such a trial would require at least 118 patients per arm.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Role of Resection of the Primary Pancreatic Neuroendocrine Tumour Only in Patients with Unresectable Metastatic Liver Disease: A Systematic Review

et al. 2011

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“…This may, however, depend on the extent of metastases, as one study found no significant difference in the survival of patients with more than 50% liver involvement treated surgically or nonsurgically [74]. …”

Section: Treatment Of Liver Metastasesmentioning

confidence: 99%

Pancreatic Neuroendocrine Tumors in the 21<sup>st</sup> Century—An Update

Kanthan¹,

Senger²,

Ahmed³

et al. 2017

JCT

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Pancreatic neuroendocrine tumors (PNETs) are rare, reported to account for less than 1% -2% of all pancreatic tumors. This, however, is likely an underestimation, as improved radiologic techniques and heightened awareness have resulted in an increase in the detection of incidentalomas, with estimations of true prevalence as high as 10%. The term "PNET" is an umbrella name that encompasses a heterogeneous group of neoplasms each with distinct clinical presentations, diagnostic radiographic features, management principles, and tumor/patient outcomes. In this context, accurate diagnosis is challenging, and management guidelines remain unclear. A high degree of clinical suspicion is required for best patient management. This manuscript provides an update on PNETs in the 21 st century, in which we re-examine the terminology, epidemiology, classification, etiopathogenesis, radiographic and histopathologic diagnostic features, management for localized and metastatic disease, as well as a review of features defining functional and non-functional PNETS, and finally deliberates on the prognosis and predictive features of this unpredictable and largely unfathomable neoplasm.

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“…In highly selected cases, even liver transplantation may be considered [7,10,[21][22][23][24][25][26]. A number of biologically targeted agents targeting the VEGF and m TOR signalling pathways have recently shown promise, with recent trials showing treatment with the VEGF tyrosine kinase inhibitor SUNITINIB or the mTOR inhibitor EVEROLIMUS improves progression free survival in patients with advanced PENTs [24][25][26][27][28]. The high rate of somatostatine receptor expression in PNETs also provides a rationale for peptide receptor radio nucleotide therapy in patients with inoperable or metastatic disease.…”

Section: Discussionmentioning

confidence: 99%

Aggressive Resection in Patients with Advanced Pancreatic Neuroendocrine Tumors: Case Report and Review of the Literature

Jarboui¹,

Hedfi²,

Baazaoui³

et al. 2014

IJCRM

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There is considerable controversy about the treatment of patients with malignant advanced pancreatic neuroendocrine tumors (PNETs). Aggressive surgery remains a potentially efficacious anti-tumor therapy but is rarely performed because of its possible morbidity and mortality. The purpose of this work is to describe a case of PNETs who underwent aggressive multivisceral pancreatic resection and the literature's review. Case report: A 52-year old man with no medical history, who presented for abdominal pain, recent constipation and intermittent rectal bleeding. Clinically, we found a tender mass of 10x7 cm in the left upper quadrant. Colonoscopy revealed an irregular lesion of 2 cm in the splenic flexure with histological diagnosis at biopsies suggesting a pancreatic neoplastic origin. Computed tomography (CT) of the abdomen demonstrated a large mass in the left pancreas invading the spleen and its vessels, the adjacent left transverse colon with sign of segmental extrahepatic portal hypertension. There were no liver metastases or suspected adenopathies. He underwent laparotomy with extended resection of the left pancreas, the spleen and the left colon. Histological examination confirmed a well differentiated PNET with Ki67 < 2%. The post operative course was uneventful. After 16 months of follow, the patient remains well. There is no sign of recurrence at CT. Conclusion: Many retrospective studies and the European neuroendocrine Tumors' (ENETs) guidelines claim that debulking and aggressive surgical resection in locally advanced PNETs should be considered in selected patients because it is technically feasible with encouraging disease-specific survival.

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Management of the primary tumor in patients with metastatic pancreatic neuroendocrine tumor: a contemporary single-institution review

Cited by 24 publications

References 19 publications

Role of Resection of the Primary Pancreatic Neuroendocrine Tumour Only in Patients with Unresectable Metastatic Liver Disease: A Systematic Review

Role of Resection of the Primary Pancreatic Neuroendocrine Tumour Only in Patients with Unresectable Metastatic Liver Disease: A Systematic Review

Pancreatic Neuroendocrine Tumors in the 21<sup>st</sup> Century—An Update

Aggressive Resection in Patients with Advanced Pancreatic Neuroendocrine Tumors: Case Report and Review of the Literature

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Management of the primary tumor in patients with metastatic pancreatic neuroendocrine tumor: a contemporary single-institution review

Cited by 24 publications

References 19 publications

Role of Resection of the Primary Pancreatic Neuroendocrine Tumour Only in Patients with Unresectable Metastatic Liver Disease: A Systematic Review

Role of Resection of the Primary Pancreatic Neuroendocrine Tumour Only in Patients with Unresectable Metastatic Liver Disease: A Systematic Review

Pancreatic Neuroendocrine Tumors in the 21&lt;sup&gt;st&lt;/sup&gt; Century—An Update

Aggressive Resection in Patients with Advanced Pancreatic Neuroendocrine Tumors: Case Report and Review of the Literature

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Pancreatic Neuroendocrine Tumors in the 21<sup>st</sup> Century—An Update