Abstracts
1997 Digestive Disease Week

Surgical experience with pancreatic and peripancreatic neuroendocrine tumors: 125 patients.

GO Phan, CJ Yeo, RH Hruban, KD Lillemoe, HA Pitt, JL Cameron. Departments of Surgery and Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD.

Background: Neuroendocrine tumors of the pancreas or peripancreatic area are rare, with an annual incidence of approximately 5 cases per million. Methods: This study retrospectively reviewed the patients who underwent surgery for these tumors at The Johns Hopkins Hospital from 1949 to 1996, inclusive. Results: There were 125 patients (65 males and 60 females), with a mean age of 51 ±1 years. Fifty-eight patients (48%) had nonfunctioning tumors, while 64 (52%) had functioning tumors, with 35 (55%) insulinomas, 23 (36%) gastrinomas, 3 (5%) VIPomas, 2 (3%) glucagonomas, and 1 (1%) ACTH-producing tumor. Ninety-eight percent of patients with functional tumors presented with appropriate signs and symptoms of hormonal excess; 86% of patients with nonfunctional tumors presented with either weight loss, abdominal pain, and/or jaundice. Preoperative computed tomography correctly localized the tumor in 66 of 87 patients (75%); angiography in 45 of 78 patients (58%);computed tomography plus angiography in 54 of 68 patients (79%). Tumors were benign in 60 patients (48%), malignant in 65 patients (52%), and were located in the head/neck/uncinate process of the pancreas in 53, body in 14, tail in 18, and duodenum in 8. The most common operative procedures performed were 50 pancreaticoduo-denectomies (40%), 39 distal pancreatectomies (31%), and 21 tumor enucleations (17%). Nine synchronous hepatic resections were done for metastases, 6 for nonfunctioning tumors. Of the evaluable patients, forty-six (43%) had post-operative complications, the most common being wound infection (15%), pancreatic fistula (14%), and delayed gastric emptying (8%). There were 3 in-hospital deaths (2.6%). With a mean follow-up of 55 ± 6 months, there have been 30 additional deaths, 23 related to disease progression. The overall 2, 5, and 10 year actuarial survivals were 82%, 63%, and 47%, respectively. The 5-year survival for patients with functional tumors was 77%, compared to 52% for those with nonfunctional tumors (p = 0.025); the 5-year survival for patients with benign tumors was 91%, compared to 49% for those with malignant tumors (p = 0.0004). By univariate analysis the most powerful predictor of negative outcome for patients with malignant tumors was positive resection margin status (p=0.003). Conclusion: This single institution experience documents low mortality and moderate morbidity for patients treated operatively for neuroendocrine tumors. The most favorable outcomes are observed in patients with benign functional tumors and in those with completely resected malignant tumors.