Surgical Resection and Multidisciplinary Care for Primary and Metastatic Pancreatic Islet Cell Carcinomas

Abstract

Surgical resection was associated with improved survival compared to medical management for any extent of disease in patients with ICC. Furthermore, adjuvant chemotherapy was not associated with survival but does warrant further examination in patients with metastatic disease.

Analysis of recurrence after the resection of pancreatic neuroendocrine tumors

“…Just as patients with small primary PNETs (less than 2 cm) can be observed per National Comprehensive Cancer Network guidelines because of their indolent behavior, patients with R1 or R1 resections can have good outcomes as our data shows the majority of these patients did not experience disease progression . Reported 5‐year survival rates of patients with advanced stages of disease range between 50% to 82% after surgical resection, transarterial chemoembolization, ablation, chemotherapy, or combination of those . Our findings suggest similar results with 96.3% 3‐year survival for those with a recurrence compared with 100% 3‐year survival for those without a recurrence.…”

“…Ki‐67 data were missing in 37.3% of the cases, and of those with available data, 57.8% of the tumors did not have expression of Ki‐67. Advanced age has been previously shown to be a strong predictor of worse survival . In one of the highest studies on PNETs, lymph node status alone was not a predictor of survival, but metastasis to the lymph nodes and liver combined was found to be a strong independent predictor …”

“…The exception has been poorly differentiated PNETs with a high proliferative index (Ki‐67 > 20) . Traditionally, chemotherapy‐based regimens have yielded an initial response, but these responses were not durable . Multiple randomized control trials targeting metastatic, recurrent or symptomatic disease are ongoing and recent reports have sparked new interest on medical management for PNETs, particularly advanced stages .…”

“…Though our analysis did not show any difference in OS between those with and without recurrence, the follow‐up of patients may not have been long enough for the differences to reach statistical significance. Although PNET's can be a indolent tumor, it is known that patients can die from metastatic disease . Therefore, information regarding predictors of recurrence is still relevant and worth investigating.…”

“…24 Traditionally, chemotherapy-based regimens have yielded an initial response, but these responses were not durable. 9,24,27 Multiple randomized control trials targeting metastatic, recurrent or symptomatic disease are ongoing and recent reports have sparked new interest on medical management for PNETs, particularly advanced stages. 11,28 Sunitinib, an oral tyrosine kinase inhibitor against vascular endothelial growth factor and platelet-derived growth factor receptors, and everolimus, an oral mammalian target of rapamycin inhibitor, have shown improved progression-free survival, with sunitinib having improved overall survival as well.…”