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Small pancreatic and periampullary neuroendocrine tumors: resect or enucleate? J Gastrointest Surg 2009 Sep;13(9):1692-8

Date

06/24/2009

Pubmed ID

19548038

Pubmed Central ID

PMC3354713

DOI

10.1007/s11605-009-0946-z

Scopus ID

2-s2.0-70349434733   91 Citations

Abstract

OBJECTIVE: The aim of this study was to compare the outcomes of enucleation versus resection in patients with small pancreatic, ampullary, and duodenal neuroendocrine tumors (NETs).

METHODS: Multi-institutional retrospective review identified all patients with pancreatic and peri-pancreatic NETs who underwent surgery from January 1990 to October 2008. Patients with tumors < or =3 cm and without nodal or metastatic disease were included.

RESULTS: Of the 271 patients identified, 122 (45%) met the inclusion criteria and had either an enucleation (n = 37) and/or a resection (n = 87). Enucleated tumors were more likely to be in the pancreatic head (P = 0.003) or functioning (P < 0.0001) and, when applicable, less likely to result in splenectomy (P = 0.0003). The rate of pancreatic fistula formation was higher after enucleation (P < 0.01), but the fistula severity tended to be worse following resection (P = 0.07). The enucleation and resection patients had similar operative times, blood loss, overall morbidity, mortality, hospital stay, and 5-year survival. However, for pancreatic head tumors, enucleation resulted in decreased blood loss, operative time, and length of stay compared to pancreaticoduodenectomy (P < 0.05).

CONCLUSION: These data suggest that most outcomes of enucleation and resection for small pancreatic and peri-pancreatic NETs are comparable. However, enucleation has better outcomes than pancreaticoduodenectomy for head lesions and the advantage of preserving splenic function for tail lesions.

Author List

Pitt SC, Pitt HA, Baker MS, Christians K, Touzios JG, Kiely JM, Weber SM, Wilson SD, Howard TJ, Talamonti MS, Rikkers LF

Author

Kathleen K. Christians MD Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Ampulla of Vater
Biopsy, Needle
Chi-Square Distribution
Cohort Studies
Duodenal Neoplasms
Female
Follow-Up Studies
Humans
Immunohistochemistry
Kaplan-Meier Estimate
Male
Middle Aged
Minimally Invasive Surgical Procedures
Neoplasm Staging
Neuroendocrine Tumors
Pancreatectomy
Pancreaticoduodenectomy
Probability
Registries
Retrospective Studies
Risk Assessment
Sphincterotomy, Endoscopic
Statistics, Nonparametric
Survival Analysis
Treatment Outcome