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PARENCHYMAL-PRESERVING RESECTION FOR PANCREATIC NEUROENDOCRINE TUMORS: ARE THE OUTCOMES JUSTIFIED?
Braden N. Miller*, Gwendolyn Garnett, Anthony Morada, Alagappan A. Annamalai, Andrew Hendifar, Deepti Dhall, Simon K. Lo, Ashley Wachsman, Nicholas N. Nissen
Cedars-Sinai Medical Center, Los Angeles, CA
OBJECTIVE: To evaluate the outcomes of segmental pancreatectomy (SP) and enucleation (EN) in the management of low- and intermediate-grade pancreatic neuroendocrine tumors (PNETs).
BACKGROUND: The extent of resection needed for PNETs is debated. The parenchymal-preserving options of SP and EN may be an alternative to more extensive resections.
DESIGN: Academic Center. Retrospective review of single-surgeon experience.
RESULTS: Forty-two patients underwent either SP (n=17) or EN (n=25) for PNETs from 2002 to 2016. Mean tumor size was 1.9 ± 1.22 cm (0.7-5.3 cm) and 15 were ≥ 2 cm. Thirty-three tumors were nonfunctional and 32 were low-grade. EN was usually performed for head lesions, and was completed laparoscopically/robotically in 17 patients (68%). Twenty-one patients underwent lymphadenectomy, with a mean lymph node count of 3.8 (1-16). Three patients (7%) had lymph node metastasis. There was no mortality. Significant post-operative morbidity occurred in 24%, and mean and median length of stay was 7.2 and 6.5 days. Grade B/C pancreatic fistulae occurred in 6 patients (14%). After a mean and median follow-up of 42 and 30 months, no patient has had tumor recurrence. There were 3 cases of de novo diabetes (7%) and 2 of exocrine insufficiency (5%). New or worsened pancreatic atrophy and/or duct dilation was demonstrated in 21% of patients on imaging follow-up. Development of pancreatic insufficiency was significantly associated with post-operative pancreatic atrophy (p=0.0001).
CONCLUSION: Parenchymal-preserving resections offer a safe and effective management option for PNETs, with low recurrence rates and excellent intermediate outcomes. Use of minimally invasive techniques and application to tumors ≥ 2 cm represent important advancements. Longer-term follow-up is needed, particularly for patients showing pancreatic atrophy.
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