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2010 Annual Meeting Abstracts

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Implications of Incidentally-Discovered Nonfunctioning Pancreatic Endocrine Tumors: Short and Long-Term Outcomes in 139 Resected Patients
*Alex B Haynes, *Vikram Deshpande, *Thun Ingkakul, *Parsia A Vagefi, *Jaclyn D Szymonifka, Sarah P Thayer, Cristina R Ferrone, Jennifer A Wargo, Andrew L Warshaw, Carlos Fernández-del Castillo
Massachusetts General Hospital, Boston, MA

Objective:
To describe the characteristics and outcomes of a cohort of patients after resection of incidentally-discovered nonfunctioning pancreatic endocrine tumors (PET)
Design:
Case series
Setting:
Academic referral hospital
Patients:
Consecutive patients with an incidentally-identified nonfunctioning PET resected between May 1977 and July 2009.
Main Outcome Measures:
Operative morbidity, disease progression and survival following resection
Results:
139 patients with median age of 56 years (range 21-85) underwent resection; tumor size ranged from 0.4 to 17.0cm, with a median of 3.0cm. There were no perioperative deaths, one delayed treatment-related mortality and 61 patients (44%) who experienced one or more perioperative complications. Using the WHO classification, 26 tumors (19%) were classified as benign, 39 (28%) as malignant, and 72 (53%) as uncertain. Complete follow-up was available for 81% of patients (median, 34.2 months). Five-year actuarial survival rate was 89% for those with benign disease, 92% for those with tumors of uncertain biology, and 50% for those with malignant tumors (p=0.011). Late metastasis, tumor recurrence, or disease progression were seen in 4% of patients with tumors initially classified as benign, 11% of uncertain tumors, and 38% of those classified as malignant (p<0.001). Of the 39 patients with tumors 2cm or smaller, 3 went on to have evidence of malignant disease (late metastasis, recurrence, or progression).
Conclusions:
Incidentally detected pancreatic endocrine tumors can display aggressive tumor behavior, even when small. While patients with malignant pathology on resection had diminished survival and increased rates of recurrence and metastasis, benign appearance on histology did not eliminate the possibility of progression. Patients with incidentally-discovered pancreatic endocrine tumors should be offered resection and need careful postoperative surveillance, even if surgical pathology suggests benign disease.


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