Aggressive multi-visceral pancreatic resections for locally advanced neuroendocrine tumours. Is it worth it?

University Surgical Unit, Southampton General Hospital, Southampton, United Kingdom.
JOP: Journal of the pancreas 02/2009; 10(3):276-9.
Source: PubMed


Traditional surgical principles state that pancreatic resection should not be contemplated when malignancies arise in the pancreas and involve other organs. While this is logic for ductal adenocarcinoma and other tumours with aggressive biological behavior; for even large neuroendocrine tumours, aggressive multivisceral resection may achieve useful palliation and excellent survival.
Case records were retrospectively analyzed.
Twelve consecutive patients (7 males, 5 females; median age 57 years, range: 37-79 years) underwent multi-visceral en bloc resections for neuroendocrine tumour arising in the pancreas between 1994 and 2008.
Three patients underwent pancreaticoduodenectomy; 9 patients had left sided pancreatic resections for neuroendocrine tumour of median diameter 9.5 cm (5-25 cm). They had a median of 3 (range: 1-4) additional organs resected. There were no post-operative deaths or late mortality with median follow up of 24 months. Five patients experienced a complication (major in 3 patients). Median disease free survival was not attained and 3 patients experienced recurrent disease mostly in the liver and may be candidates for further resection.
Aggressive multi-visceral resection for locally advanced neuroendocrine tumour involving the pancreas is technically feasible and in selected patients can be achieved with low mortality and acceptable morbidity, offering good disease free and overall survival. However this complex surgery should be only performed in specialist centers.

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    • "Among the various surgical and resection methods used in patients with NET, conventional wisdom suggests that patients with multiple metastases should not be considered for resection. However, studies in patients with multiple metastases (including hepatic) have suggested that surgical resection in select patients with advanced, multiple metastatic NET may have acceptable risks (Norton et al. 2003; Abu et al. 2009). Although surgical resection increases the healthcare costs for patients with NET, the potential survival benefits should be considered. "
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    ABSTRACT: Neuroendocrine tumours (NET) are often diagnosed at an advanced stage when the prognosis is poor for patients, who often experience diminished quality of life (QoL). As new treatments for NET become available, it is important to characterise the associated outcomes, costs and QoL. A comprehensive search was performed to systematically review available data in advanced NET regarding cost of illness/resource utilisation, economic studies/health technology assessment and QoL. Four rounds of sequential review narrowed the search results to 22 relevant studies. Most focused on surgical procedures and diagnostic tools and contained limited information on the costs and consequences of medical therapies. Multiple tools are used to assess health-related QoL in NET, but few analyses have been conducted to assess the comparative impact of available treatment alternatives on QoL. Limitations include English language and the focus on advanced NET; ongoing terminology and classification changes prevented pooled statistical analyses. This systematic review suggests a lack of comparative economic and outcomes data associated with NET treatments. Further research on disease costs, resource utilisation and QoL for patients with advanced NET is warranted.
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    • "As many PNETs are nonfunctioning and slow-growing, a large proportion of these present with locally advanced disease. Resection for locally advanced PNETs is in general technically feasible and can result in favorable disease-free and overall survival in selected patients [51]. However, most patients will develop recurrence [52]. "
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    The Scientific World Journal 12/2012; 2012(1):357475. DOI:10.1100/2012/357475 · 1.73 Impact Factor
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    • "Also operative factors such as operation time, intraoperative blood loss or the amount of intraoperative administered erythrocyte concentrates were not significantly increased in comparison to pancreas resections alone in NMPA-patients. In accordance to recent studies the results of our study demonstrate that surgical therapy of HMPA is not limited by technical feasibility and not automatically associated with an increase in postoperative complications [36]. A margin negative resection status (R0-status) was at least reached in 7 patients (32%) in the HMPA-group. "
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    ABSTRACT: Backround. Pancreas resection is the only curative treatment for pancreatic adenocarcinoma. In the event of unexpected incidental liver metastases during operative exploration patients were traditionally referred to palliative treatment arms. With continuous progress in the surgical expertise simultaneous pancreas and liver resections seem technically feasible nowadays. The aim of this study therefore was to analyze the impact of synchronous liver-directed therapy on operative outcome and overall survival in patients with hepatic metastasized pancreatic adenocarcinoma (HMPA). Methods. 22 patients who underwent simultaneous pancreas resection and liver-directed therapy for HMPA between January 1, 2004 and January 1, 2009 were compared to 22 patients who underwent classic pancreas resection for nonmetastasized pancreatic adenocarcinoma (NMPA) in a matched pair study design. Postoperative morbidity, preoperative, and operative data and overall survival were analyzed. Results. Overall survival was significantly decreased in the HMPA group. Postoperative morbidity and mortality and median operation time did not significantly differ between the groups. Conclusion. The results of our study showed that simultaneous pancreas resection and liver-directed therapy may safely be performed and may therefore be applied in individual patients with HMPA. However, a potential benefit of this radical surgical approach with regard to overall survival and/or quality of life remains to be proven.
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