Surgical Treatment of Pancreatic Neuroendocrine Tumours - Clinical Experience

Abstract

the aim of the work was the clinical characteristics and analysis of preliminary results for surgical treatment of pancreatic neuroendocrine tumors (PNETs), based on own material. material and methods. In the period from 2005 to 2009, in the Department of Gastrointestinal Surgery, Silesian Medical University in Katowice, there were 27 patients (15 males and 12 females) treated surgically for pancreatic neuroendocrine tumours, constituting 65.86% (27/41) of all gastroenteropancreatic neuroendocrine tumours. Prior to the surgery, the following diagnostic examinations were performed: laboratory tests and imaging examinations (abdominal ultrasound and CT scan). The following tumour localisation was established: head of the pancreas -14, body of the pancreas -4, tail of the pancreas -5, body and tail of the pancreas -1, retroperitoneal space -4. There were found 24 (88.89%) primary tumours and 3 (11.11%) recurrences. The following methods of surgical treatment were applied: pancreatoduodenectomy -11, distal pancreatic resection with splenectomy -6, middle segment resection with anastomosis between the pancreatic tail and jejunal loop: Roux-Y procedure -1, pancreatic resection by Beger procedure -1, pancreatic head and body resection with splenectomy -1, tumour enucleation or local excision -4, exploratory laparotomy with specimen collection -3. Results. The mean hospitalisation period was 25 days (4 -78 days). The mean procedure duration was 4.2 hours (1.15-9.15 hours). Early post-operative complications were observed in 10 patients (37.04%). The following early complications were observed: intra-abdominal abscess -2, wound suppuration -2, pancreatic fistula -1, acute pancreatitis -1, pancreaticojejunal anastomosis leak -1, peritoneal cavity haemorrhage -1, acute cholangitis -1, adhesion obstruction -1, subobstruction -1, portal vein thrombosis -1, sepsis -1, fluid in pleural cavity -1, acute heart failure -1. There were performed 2 (7.41%) repeat surgeries: one due to adhesion obstruction and one due to peritoneal cavity haemorrhage. Death of 1 patient (3.71%) was recorded in the post-operative period due to acute heart failure. conclusions. Pancreatic neuroendocrine tumours constituted the majority of gastroenteropancreatic neuroendocrine tumours in the analysed patient group. Most commonly, PNETs were localised in the head of the pancreas. In the presented material, the mortality rate does not exceed 4%, similarly as in other renowned centres.

Pancreatic cysts: etiology, diagnosis and management

“…Most (85%) post-inflammatory (especially due to an acute pancreatitis) pseudocysts have a tendency to spontaneous resorption within 4-6 weeks [2,71]. After this period, spontaneous resorption of the cyst is unlikely.…”

“…Therefore, descriptive "pancreatic cystic lesions" is used to define all pancreatic cysts [1,2]. There are different classifications of pancreatic cystic lesions in the literature.…”

“…According to epithelial lining of the pancreatic cysts, they are divided into true cysts (lined with the epithelium) and pseudocysts (without the epithelium) [1]. According to development type and etiology, they are divided into primary and secondary cysts [2,3]. Primary lesions include the following pathologies: pseudocysts, serous cystic neoplasms (cystadenoma and cystadenocarcinoma), mucinous non-neoplastic cysts, mucinous cystic neoplasms (cystadenoma and cystadenocarcinoma), intraductal papillary mucinous neoplasms (IPMNs), solid pseudopapillary tumors and lymphoepithelial cysts.…”

“…Primary lesions include the following pathologies: pseudocysts, serous cystic neoplasms (cystadenoma and cystadenocarcinoma), mucinous non-neoplastic cysts, mucinous cystic neoplasms (cystadenoma and cystadenocarcinoma), intraductal papillary mucinous neoplasms (IPMNs), solid pseudopapillary tumors and lymphoepithelial cysts. Secondary lesions are a result of the transformation of solid pancreatic tumors (adenocarcinomas and neuroendocrine tumors) in the cystic forms [2,3]. Pseudocysts due to acute and chronic pancreatitis are most common pancreatic cysts (70%) [1][2][3][4][5][6].…”

“…Secondary lesions are a result of the transformation of solid pancreatic tumors (adenocarcinomas and neuroendocrine tumors) in the cystic forms [2,3]. Pseudocysts due to acute and chronic pancreatitis are most common pancreatic cysts (70%) [1][2][3][4][5][6]. Pancreatic cystic neoplasms constitute less than 1% of all pancreatic tumors [1].…”