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Evolving Patterns in the Detection of Pancreatic Neuroendocrine Tumors (PNETs): The Massachusetts General Hospital Experience from 1977-2005
Parsia A Vagefi, Oswaldo Razo, Vikram Deshpande, Gregory Y. Lauwers, Sarah P. Thayer, Andrew L. Warshaw, Carlos Fernandez-Del Castillo
Massachusetts General Hospital/Harvard Medical School, Boston, MA
Objective: To assess changing patterns in the detection of PNETs.
Design: Retrospective review from 1977 to 2005.
Setting: Tertiary care referral center.
Patients: 172 patients (51 % male, mean age 55 years) who underwent surgery for histologically confirmed PNETs.
Main Outcome Measures: Surgical outcomes, survival, and changes in presentation of PNETs in 2 time groups: 1977-1999 (80 patients) and 2000-2005 (92 patients).
Results: Ninety-seven patients (56.4%) had non-functioning PNETs, 83 of which were incidental. Insulinomas were the most common of functioning tumors (33%), then gastrinomas and glucagonomas; 12 patients (7%) had MEN 1. Overall, 60% of tumors were located in the pancreatic body or tail. A Whipple procedure was performed in 23%, distal pancreatectomy in 53%, and the rest had either middle pancreatectomy or enucleation. There were no operative deaths. 74% of tumors were classified as benign; of those classified as malignant, 25% had liver metastases. 10.5% of patients received adjuvant therapy. Complete follow up was available in 90% of patients (mean duration 63.3 months). The 5 and 10-year actuarial survival were 77% and 62%, respectively. Incidentally-discovered non-functioning tumors were significantly more frequent in the last five years (58% vs 38%, p=0.01), with a trend towards smaller tumors (4.2 vs 5.6 cm, p=0.19), and lesser likelihood of malignancy (21% vs 40%, p=0.1).
Conclusion: We report here the largest single center experience with PNETs. Increasing number of PNETs are being resected, largely due to incidental detection of non-functioning neoplasms. This may be leading to treatment of smaller and less malignant tumors.
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