Operative Versus Nonoperative Management of Nonfunctioning Pancreatic Neuroendocrine Tumors

J Gastrointest Surg. 2016 Feb;20(2):277-83. doi: 10.1007/s11605-015-3043-5. Epub 2015 Dec 21.


Introduction: Surgical resection is the only curative treatment for pancreatic neuroendocrine tumors (PNETs), but pancreatic operations carry a significant morbidity. We investigated whether the resection of small, asymptomatic nonfunctioning PNETs is beneficial. Clinicopathologic factors were retrospectively reviewed for all PNET cases from 1998 to 2014.

Methods: Kaplan-Meier survival and multivariable regression analyses were performed. A total of 249 patients had nonfunctioning PNETs with adequate follow-up, of whom 193 were resected and 56 were observed. Median age was 56 years, and 48 % of the patients were female.

Results: Overall, the resected patients had a significantly longer survival (OS) (p = 0.001). However, for the patients with PNETs ≤2.5 cm in size and without metastasis at presentation, tumor size significantly modified the effect of resection on overall survival (p < 0.05). The protective effect of resection increased as tumor size increased. An operation became a significant predictor of overall survival for tumors >1.5 cm (p = 0.050 or less for larger tumors) but was not significant for tumors <1.5 cm (p = 0.317 or more for smaller tumors), controlling for age-adjusted Charlson comorbidity index.

Conclusion: Resection of nonfunctioning PNETs over 1.5 cm is independently and significantly associated with a longer survival. However, the benefit of resection for tumors under 1.5 cm is unclear.

Keywords: Nonfunctioning; Pancreatic neuroendocrine tumor; Resection; Size; Surgery.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neuroendocrine Tumors / mortality
  • Neuroendocrine Tumors / pathology*
  • Neuroendocrine Tumors / surgery*
  • Pancreatic Neoplasms / mortality
  • Pancreatic Neoplasms / pathology*
  • Pancreatic Neoplasms / surgery*
  • Patient Selection
  • Retrospective Studies
  • Survival Rate
  • Treatment Outcome
  • Young Adult

Supplementary concepts

  • Non functioning pancreatic endocrine tumor