Resection versus expectant management of small incidentally discovered nonfunctional pancreatic neuroendocrine tumors

Surgery. 2016 Jan;159(1):302-9. doi: 10.1016/j.surg.2015.10.013. Epub 2015 Nov 4.

Abstract

Background: Sporadic, nonfunctional pancreatic neuroendocrine tumors (NF-PNETs) are diagnosed with increasing frequency. We compared the risk of tumor growth, metastasis, and mortality between patients treated versus those treated expectantly.

Method: A retrospective study of patients seen at our institution with sporadic NF-PNETs, with ≥ 12 months of follow-up. Kaplan-Meier analysis was performed.

Results: Between 1999 and 2014, 35 patients with an incidentally discovered nonfunctional PNET were identified. Twenty underwent resection and 15 were followed with imaging. In the operative group, 8 had NF-PNETs < 2 cm, while 12 had NF-PNETs ≥ 2 cm. In the nonoperative expectant management by serial imaging group, 10 had NF-PNETs < 2 cm while 5 had NF-PNETs ≥ 2 cm. Small NF-PNETs (<2 cm) in either the operative or nonoperative groups demonstrated no evidence of progression or metastasis (median follow-up of 27.8 months). Morbidity in the operative group was 35% with pancreatic pseudocyst the most common.

Conclusion: Incidentally discovered NF-PNETs < 2 cm in size can be observed safely with serial imaging.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Disease Progression
  • Female
  • Humans
  • Incidental Findings
  • Male
  • Middle Aged
  • Neuroendocrine Tumors / mortality
  • Neuroendocrine Tumors / pathology
  • Neuroendocrine Tumors / therapy*
  • Pancreatectomy*
  • Pancreatic Neoplasms / mortality
  • Pancreatic Neoplasms / pathology
  • Pancreatic Neoplasms / therapy*
  • Patient Selection
  • Prognosis
  • Retrospective Studies
  • Watchful Waiting*

Supplementary concepts

  • Non functioning pancreatic endocrine tumor