Cytoreduction results in high perioperative mortality and decreased survival in patients undergoing pancreatectomy for neuroendocrine tumors of the pancreas

J Gastrointest Surg. 2006 Dec;10(10):1361-70. doi: 10.1016/j.gassur.2006.09.004.


We reviewed our experience with pancreatectomy for neuroendocrine tumors (NE) to determine outcomes after R0/R1 or R2 resection and compare them to patients in whom resection was not attempted. Data were reviewed for all patients presenting with NE tumors of the pancreas between 1990 and 2005. Kaplan-Meier survival curves were compared by log-rank analysis. Multivariate analysis was completed using Cox proportional hazards to identify risk factors for poor survival after resection. Of 120 patients, 65 (54%) had functional tumors. Resection was undertaken in 83: distal pancreatectomy in 41, pancreaticoduodenectomy in 27, enucleation in 14, and central pancreatectomy in 1. Survival was significantly longer after resection (91 months versus 24, P<0.001). R0/R1 resection was accomplished in 64 (77%) and resulted in lower perioperative mortality (2% versus 21%, P<0.01) and longer survival (112 months versus 24, P<0.001) compared to R2 resection. Survival after R2 resection was no better than after no resection. Factors predictive of decreased survival were moderate/poor differentiation, R2 resection, and high-risk features. Long-term survival is possible following complete resection for NE tumors of the pancreas. However, cytoreduction resulting in incomplete tumor removal carries significant perioperative mortality without long-term survival benefit and should be discouraged.

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Islet Cell / mortality
  • Carcinoma, Islet Cell / surgery
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neuroendocrine Tumors / mortality*
  • Neuroendocrine Tumors / surgery*
  • Pancreatectomy*
  • Pancreatic Neoplasms / mortality*
  • Pancreatic Neoplasms / surgery*
  • Proportional Hazards Models
  • Survival Analysis
  • Survival Rate
  • Treatment Outcome