One Hundred Thirty Resections for Pancreatic Neuroendocrine Tumor: Evaluating the Impact of Minimally Invasive and Parenchyma-Sparing Techniques
ABSTRACT Increasingly, surgeons apply minimally invasive and parenchyma-sparing techniques to the management of pancreatic neuroendocrine tumor (PNET). The aim of this study was to evaluate the impact of these approaches on patient outcomes.
We retrospectively collected data on patients with PNET and compared perioperative and pathologic variables. Survival was analyzed using the Kaplan-Meier method. Factors influencing survival were evaluated using a Cox proportional hazards model.
One hundred thirty patients underwent resection for PNET. Traditional resections included 43 pancreaticoduodenectomies (PD), 38 open distal pancreatectomies (DP), and four total pancreatectomies. Minimally invasive and parenchyma-sparing resections included 25 laparoscopic DP, 11 central pancreatectomies, five enucleations, three partial pancreatectomies, and one laparoscopic-assisted PD. Compared to traditional resections, the minimally invasive and parenchyma-sparing resections had shorter hospital stays. By univariate analysis of neuroendocrine carcinoma, liver metastases and positive resection margins correlated with poor survival. There was an increase in minimally invasive or parenchyma-sparing resections over the study period with no differences in morbidity, mortality, or survival.
In this series, there has been a significant increase in minimally invasive and parenchyma-sparing techniques for PNET. This shift did not increase morbidity or compromise survival. In addition, minimally invasive and parenchyma-sparing operations yielded shorter hospital stays.
- SourceAvailable from: Bjørn Edwin
[Show abstract] [Hide abstract]
- "Over the last decade there has been a trend towards more parenchyma-sparing and minimally invasive techniques in the management of PNETs. This shift has not increased morbidity or compromised survival . Laparoscopic surgery for small and solitary PNETs is feasible and safe [78–81]. "
ABSTRACT: Pancreatic neuroendocrine tumors (PNETs) are rare neoplasms. They are clinically diverse and divided into functioning and nonfunctioning disease, depending on their ability to produce symptoms due to hormone production. Surgical resection is the only curative treatment and remains the cornerstone therapy for this patient group, even in patients with advanced disease. Over the last decade there has been a noticeable trend towards more aggressive surgery as well as more minimally invasive surgery in patients with PNETs. This has resulted in improved long-term survival in patients with locally advanced and metastatic disease treated aggressively, as well as shorter hospital stays and comparable long-term outcomes in patients with limited disease treated minimally invasively. There are still controversies related to issues of surgical treatment of PNETs, such as to what extent enucleation, lymph node sampling, and vascular reconstruction are beneficial for the oncologic outcome. Histopathologic tumor classification is of high clinical importance for treatment planning and prognostic evaluation of patients with PNETs. A constant challenge, which relates to the treatment of PNETs, is the lack of an internationally accepted histopathological classification system. This paper reviews current issues on the surgical treatment of sporadic PNETs with specific focus on surgical approaches and tumor classification.The Scientific World Journal 12/2012; 2012(1):357475. DOI:10.1100/2012/357475 · 1.73 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: 目的 探讨电针对消化道肿瘤患者围手术及围化疗期T淋巴细胞亚群和淋巴细胞转化功能的影响。 方法 将44 例消化道肿瘤患者分为4 组, 手术切除组, 手术切除+电针组, 手术切除+化疗组, 手术切除+化疗+电针组。 采用流式细胞仪测定消化道肿瘤患者不同阶段T淋巴细胞亚群的变化, MTT法检测外周血淋巴细胞转化功能。 结果 手术后第3 d, 患者CD3+细胞百分率及淋巴细胞转化功能低于手术前 (P<0.05, P<0.01); 电针治疗患者CD3+细胞百分率及淋巴细胞转化功能无明显降低, 与手术切除组比较, 差异有统计学意义(P<0.05)。 手术后第10 d, 患者淋巴细胞转化功能基本恢复至术前水平, 电针治疗患者CD8+细胞明显减少(P<0.05), CD4+/CD8+比值显著升高(P<0.05)。 手术并化疗后第3 d, CD3+细胞百分率及CD4+/CD8+比值较术前降低, 但差异无统计学意义。 电针干预后, 手术加化疗后第3 d患者的CD3+细胞百分率及CD4+/CD8+比值明显提高(P<0.05)。 与手术前自身比较, 电针治疗能提高手术及化疗后患者的淋巴细胞转化功能(P<0.01)。 结论 电针可明显改善消化道肿瘤患者围手术期及围化疗期的细胞免疫功能。Journal of Acupuncture and Tuina Science 12/2011; 9(6). DOI:10.1007/s11726-011-0550-0
- [Show abstract] [Hide abstract]
ABSTRACT: Pancreatic neuroendocrine tumors (PNETs) are rare tumors, with an incidence of one per 100, 000 individuals per year, and they account for 1-2% of all pancreatic neoplasms. PNETs are a heterogeneous group with varying clinical presentation, tumor biology and prognosis. This article reviews the current diagnostic strategy and treatment armamentarium for PNETs. Special attention is paid to recent and ongoing developments in treatment, particularly with regards to multimodality treatment and newer systemic therapies for unresectable disease. There has been significant progress in the genetic understanding of hereditary syndromes in regards to PNETs, as well as in the diagnosis and treatment of resectable and nonresectable PNETs. Whereas surgical therapy remains the most advisable therapy for resectable neuroendocrine tumors of the pancreas, there have been significant recent advances in systemic therapy for those with unresectable disease. Results from recent clinical trials examining mammalian target of rapamycin inhibitors and tyrosine kinase inhibitors for unresectable disease are promising in expanding treatment options for metastatic PNETs. Neuroendocrine tumors of the pancreas are a heterogeneous group of tumors with varying clinical presentation, tumor biology and prognosis. Clinicians must be aware of the variety of manifestations of this disease, as well as the role of systemic chemotherapy in treatment of unresectable disease.Current opinion in oncology 11/2011; 24(1):46-55. DOI:10.1097/CCO.0b013e32834c554d · 4.47 Impact Factor