Pancreatic endocrine tumors with major vascular abutment, involvement, or encasement and indication for resection

Department of Surgery, Stanford University Medical Center, Stanford, CA 94305-5641, USA.
Archives of surgery (Chicago, Ill.: 1960) (Impact Factor: 4.93). 06/2011; 146(6):724-32. DOI: 10.1001/archsurg.2011.129
Source: PubMed


Surgery for pancreatic endocrine tumors (PETs) with blood vessel involvement is controversial.
Resection of PETs with major blood vessel involvement can be beneficial.
The combined databases of the National Institutes of Health and Stanford University hospitals were queried.
Operation, pathologic condition, complications, and disease-free and overall survival.
Of 273 patients with PETs, 46 (17%) had preoperative computed tomography evidence of major vascular involvement. The mean size for the primary PET was 5.0 cm. The involved major vessel was as follows: portal vein (n = 20), superior mesenteric vein or superior mesenteric artery (n = 16), inferior vena cava (n = 4), splenic vein (n = 4), and heart (n = 2). Forty-two of 46 patients had a PET removed: 12 (27%) primary only, 30 (68%) with lymph nodes, and 18 (41%) with liver metastases. PETs were removed by either enucleation (n = 7) or resection (n = 35). Resections included distal or subtotal pancreatectomy in 23, Whipple in 10, and total in 2. Eighteen patients had concomitant liver resection: 10 wedge resection and 8 anatomic resections. Nine patients had vascular reconstruction: each had reconstruction of the superior mesenteric vein and portal vein, and 1 had concomitant reconstruction of the superior mesenteric artery. There were no deaths, but 12 patients had complications. Eighteen patients (41%) were immediately disease free, and 5 recurred with follow-up, leaving 13 (30%) disease-free long term. The 10-year overall survival was 60%. Functional tumors were associated with a better overall survival (P < .001), and liver metastases decreased overall survival (P < .001).
These findings suggest that surgical resection of PETs with vascular abutment/invasion and nodal or distant metastases is indicated.

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    • "This shows that in most cases, even if the radiological evaluation suggests vascular involvement and at surgery the PNET is found to partially encase or involve the vessel, the tumor can be removed with careful dissection without requiring vascular reconstruction. Conventional contraindications to surgical resection of pancreatic malignancy, such as superior mesenteric vein invasion, should be reconsidered in patients with locally advanced PNETs [52, 110]. "
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