Back to Program

Background Pancreatic neuroendocrine tumors (PNET) are rare lesions that, when treated with curative resection, are associated with prolonged survival. Increasingly, surgeons apply minimally invasive and parenchymal-sparing techniques in the surgical management of PNET. Objective To evaluate the impact of minimally invasive and parenchymal-sparing approaches on PNET patient morbidity and survival. Methods We retrospectively collected demographic and perioperative data on PNET patients who underwent pancreatectomy between October 1994 and June 2009. For comparison, patients were divided into early and recent patient groups: 63 from 1994 to 2006 and 64 from 2006 to present. Variables were compared using t-test, Wilcoxon rank-sum, or Fisher’s exact test. Survival was compared using Kaplan-Meier and log-rank test. A Cox proportional-hazards regression analyzed pathological factors influencing survival. Results With a mean age of 60.8 years, 127 patients underwent resection for PNET. Formal resections included 61 distal pancreatectomy (23 laparoscopic), 44 pancreaticoduodenectomy, and 3 total pancreatectomy. Parenchymal-sparing resections included 11 central pancreatectomy, 5 enucleation, and 3 partial pancreatectomy. One hundred six patients (83.5%) had nonfunctional tumors, of which 61 (57.5%) were benign and 45 (42.5%) were malignant carcinoma. Twenty-one patients (16.5%) had functional tumors, of which 16 (76.2%) were benign and 5 (23.8%) were malignant carcinoma. With a median follow-up of 40 months, the 5-year survival for patients with malignant carcinoma was 66.6%. By univariate analysis of patients with malignant carcinoma, liver metastases and positive resection margins correlated with poor survival (p<0.05). Lymphovascular invasion, perineural invasion, tumor size, and positive lymph nodes were not significantly associated with differences in survival. In the recent group, there was a significant increase in laparoscopic and parenchymal-sparing resections compared to the early group (31, 49% vs. 12, 19%; p<0.05). There were no differences in morbidity (47.6% vs. 42.4%, p=0.59), mortality (0% vs. 6.3%, p=0.12), or median survival (p=0.72) between early and recent groups. Compared to patients who had formal resections, the laparoscopic and parenchymal-sparing patients had shorter postoperative hospital stays (p<0.05).Conclusion In this series, there has been a significant increase in minimally invasive and parenchymal-sparing techniques for PNET patients. This shift is associated with a reduced postoperative length of stay and does not increase patient morbidity or compromise patient survival.