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Contemporary Surgical Treatment of Neuroendocrine Tumors of the Pancreas
Vitaliy Y Poylin, Charles M Vollmer, Jr., Wande Pratt, Per-Olof Hasselgren, Mark P Callery
Beth Israel Deaconess Medical Center, Boston, MA
Objective: To analyze a recent surgical experience with pancreatic neuroendocrine tumors.
Design: Prospectively collected case series.
Setting: Academic referral center.
Patients: : Pancreatic resections for neuroendocrine tumors (2001-2006).
Main Outcome Measures: Demographics, symptoms, diagnostic modalities, tumor histology, type of surgical procedure, complications, and LOS.
Results: Twenty-six patients were evenly distributed between younger (<65) and older cohorts, with a 20-year difference in mean age at presentation (51.9 and 71.3 years) respectively. Overall, 28% were functional tumors with symptoms characteristic of the secreted hormone (6 insulinoma, 1 gastrinoma). Nonfunctioning tumors usually presented with abdominal pain, nausea and vomiting (n=16), or incidentally (n=3). 70% of patients required more then one of the following imaging modalities for diagnosis: CT, MRI, abdominal ultrasound, octreotide scan, or ERCP. Tumors were evenly distributed between head (n=11), body (n=7), and tail (n=8). When compared to the older cohort, younger patients' tumors were significantly bigger (5.25 vs. 1.4cm), predisposed towards the tail (42 vs. 25%), and were more often malignant (42% vs. 0%). Twenty-one patients had open surgical procedures including: pancreaticoduodenectomy (n=6), distal pancreatectomy (n=12), enucleation (n=2), or laparotomy with biopsy (n=1). Twenty percent of the cases were performed minimally invasively, with lower EBL and decreased LOS (8.3 vs. 4.6 days). Fifteen complications occurred in 12 patients (46%), with no operative (30 days) mortality.
Conclusions: Surgical management of pancreatic neuroendocrine tumors remains challenging owing to disease heterogeneity, difficulties in diagnosis, and the multitude of available surgical techniques, including laparoscopy.
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