Surgical Treatment of Pancreatic Neuroendocrine Tumors: Report of 112 Cases

Abstract

Objectives: To review the clinical data of a group of patients with pancreatic neuroendocrine tumors (pNETs) and to investigate the role of surgery in the treatment for pNETs by analyzing clinical manifestations and postoperative course of this rare disease. Methods: A total of 112 patients (aged 21–76 years; 45 males) who underwent treatment between 1980 and 2003 were recruited in this study. Patients’ data related to demographics and characteristics, diagnostic studies, surgical and tumor characteristics and survival were retrospectively reviewed. Results: Forty-six patients (41.1%) had a well-differentiated neuroendocrine tumor (WDT), 44 (48.2%) a well-differentiated neuroendocrine carcinoma (WD-Ca) and 12 (10.7%) a poorly differentiated neuroendocrine carcinoma (PD-Ca). Nonfunctional tumors were seen in 65 (58.0%) patients, whereas functional tumors were found in 47 (42.0%) patients, including 26 insulinomas, 17 gastrinomas, 2 VIPomas, 1 glucagonoma, and 1 ACTHoma. The sensitivity of computed tomography was 87.1%. Surgical resection was performed in 99 (88.4%) patients. Thirty-eight (33.9%) patients underwent partial pancreaticoduodenectomy, 32 (28.6%) had distal pancreatectomy and 29 (25.9%) underwent enucleation. No surgery-related death occurred. The common postoperative complications were pancreatic fistula (15.2%), wound infection (13.4%) and delayed gastric emptying (6.3%). Three (5%) patients had reoperation due to intra-abdominal abscess and postoperative hemorrhage. Twenty-six (55.3%) of the 47 functional tumors were malignant, whereas 40 (61.5%) of the 65 nonfunctional tumors were malignant. Survival was significantly related to the type of neuroendocrine tumor (p = 0.001). The overall 5-year actual survival rate of patients with WD-Ca (n = 54) was 56%, significantly less than that of patients with WDT (n = 46, 91%, p = 0.001). All the patients of PD-Ca (n = 12) group died in 5 years. The 5-year survival rate differed significantly between patients with tumor node metastasis (TNM) stage I and II disease and those with stage III and IV tumors (p = 0.011). Patients with stage III had better prognosis than those with stage IV tumors (p = 0.007). Patients’ long-term survival was closely correlated with vascular invasion (p = 0.008) and resection margin (p = 0.004). Conclusions: PNETs can be safely resected. Microscopic vascular invasion and positive resection margin are helpful for predicting patient survival. Malignant cases should be treated with aggressive radical surgery to achieve complete tumor resection and potential for long-term survival.

A meta-analysis of Prognostic factor of Pancreatic neuroendocrine neoplasms

“…TMN stage was mentioned in 4 articles 18 , 22 , 24 , 25 . On the basis of current knowledge, people with advanced TMN stage are more likely to have a negative outcome.…”

Prognostic factors and survival in patients with neuroendocrine tumors of the pancreas

“…Gao et al [18] found that the overall 5-year actual survival rate of patients with well-differentiated neuroendocrine carcinoma was 56%, significantly less than patients with well-differentiated neuroendocrine tumor (91%; p=0.001). All the patients of poorly differentiated neuroendocrine carcinoma died in 5 years.…”

Well-Differentiated Neuroendocrine Neoplasia: Relapse-Free Survival and Predictors of Recurrence after Curative Intended Resections

“…Microangioinvasion has been described as risk factor for metastases in rectal NETs [32]. In patients with pancreatic NET microangioinvasion was associated with higher risk of recurrence [33] and shorter long-term survival [34]. In the study of Boninsegna et al [15], microangioinvasion was predictive for recurrence in univariate analysis but failed to be confirmed as independent predictive parameter in multivariate analysis.…”