Small pancreatic and periampullary neuroendocrine tumors: resect or enucleate?

J Gastrointest Surg. 2009 Sep;13(9):1692-8. doi: 10.1007/s11605-009-0946-z. Epub 2009 Jun 23.

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.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

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