Article

Surgery in malignant pancreatic neuroendocrine tumors

Department of Surgery, Division of General Surgery, The Mount Sinai School of Medicine, New York, New York 10029-6574, USA.
Journal of Surgical Oncology (Impact Factor: 2.84). 10/2007; 96(5):397-403. DOI: 10.1002/jso.20824
Source: PubMed

ABSTRACT Because of their rarity and indolent nature, optimal management of malignant pancreatic neuroendocrine tumors remains controversial. The purpose of this study is to review a series of patients with these tumors and investigate the role of surgery in the treatment.
A retrospective study of 73 patients (ages 24-86 years; 36 women) undergoing treatment at a tertiary academic medical center was performed. Patient demographics, diagnostic tests, operations, pathologic findings, adjuvant treatments, and survival were reviewed.
Seventy-four percent of patients had advanced disease with hepatic metastases and 30% had functional tumors. Fifty-seven percent of the patients underwent pancreatic resections. Two 60-day mortalities occurred and the postoperative complication rate was 27%. Overall 5-year survival rate was 44%. There was no difference in survival between patients with functional and nonfunctional tumors. Patients undergoing resection, even in metastatic disease, had better survival than patients who had no resection (60% vs. 30%, P = 0.025). Recurrence occurred in 20% of patients who underwent a curative resection.
Patients with malignant pancreatic neuroendocrine tumors commonly present with advanced disease. Although, curative resection is not frequent, survival benefit may be obtainable with aggressive surgical management even in the face of metastatic disease.

0 Followers
 · 
96 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Pancreatic neuroendocrine tumors are rare neoplasms often associated with a clinical syndrome. Their rarity makes a comprehensive study difficult at any single institution, while their uniqueness makes them desirable for investigation. This review summarizes recent information and advancements concerning pancreatic neuroendocrine tumor diagnosis, imaging characteristics, treatment algorithms, and staging. Insulinomas and gastrinomas comprise the majority of functional pancreatic neuroendocrine tumors. Advances in their identification and diagnostic evaluation, imaging techniques, and treatment algorithms are presented. Furthermore, a new staging classification system has been proposed which may significantly improve the ability to conduct future multi-institutional investigations on pancreatic neuroendocrine tumors. Although rare, a thorough understanding of pancreatic neuroendocrine tumors is essential for all physicians due to the wide variety of symptoms with which patients present. Currently, patients are often misdiagnosed for extended periods of time. This review summarizes the recently published literature about diagnosis, imaging, treatment, and staging of pancreatic neuroendocrine tumors.
    Current Opinion in Oncology 02/2008; 20(1):25-33. DOI:10.1097/CCO.0b013e3282f290af · 3.76 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Pancreatic neuroendocrine tumors (PNETs) comprise a heterogeneous group of neoplasms for which treatment is variable, depending on the clinical stage. Despite this diversity, surgery remains the gold standard in the management of PNETs. This paper discusses whether aggressive surgical intervention is indicated for PNETs and investigates what prognostic factors may assist in predicting which patients with invasive disease will benefit most from surgical intervention. A review was conducted of large surgical series reported in the English literature over the last 10 years as they pertain to current surgical intervention in PNETs and of prognostic factors related to surgical outcome and survival. Improved survival can be achieved with aggressive surgical management of PNETs. The presence of hepatic metastases is not a contraindication to surgical resection of the primary PNET. Results of series that reported prognostic factors are heterogeneous. Aggressive surgical resection for selected individuals with PNETs can be performed safely and may improve both symptomatic disease and overall survival. Consideration for resection of primary PNETs should be given to patients with treatable hepatic metastases. Prognostic indices such as tumor differentiation and ability to achieve R0/R1 resection have been linked to survival outcome in PNETs and should be considered when planning aggressive surgical management for this disease.
    Cancer control: journal of the Moffitt Cancer Center 11/2008; 15(4):314-21. · 2.66 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Neuroendocrine tumours are tumours of cells which possess secretory granules and originate from the neuroectoderm. While liver resection is generally advocated in patients with resectable liver alone metastases, the management of patients with liver metastases, which cannot be completely resected, is controversial. To determine if cytoreductive surgery is better than other palliative treatments in patients with liver metastases from gastro-entero-pancreatic neuroendocrine tumours, which cannot be completely resected. We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, and LILACS until July 2008 for identifying the randomised trials. Only randomised clinical trials (irrespective of language, blinding, or publication status) comparing liver resection (alone or in combination with radiofrequency ablation or cryoablation) versus other palliative treatments (chemotherapy or hormone-therapy or immunotherapy) or no treatment in patients with liver metastases from neuroendocrine tumours, which cannot be completely resected, were considered for the review. Two authors independently identified trials for inclusion. We were unable to identify any randomised clinical trial suitable for inclusion in this review. The literature provides no evidence from randomised clinical trials in order to assess the role of cytoreductive surgery in non-resectable liver metastases from gastro-entero-pancreatic neuroendocrine tumours. High-quality randomised clinical trials may become feasible to perform if their conduct and study design is thoroughly considered in all their practical and methodological aspects. Pilot randomised clinical trials, which can guide the study design of definitive randomised clinical trials, are necessary.
    Cochrane database of systematic reviews (Online) 02/2009; DOI:10.1002/14651858.CD007118.pub2 · 5.94 Impact Factor