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.
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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.
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