Abstract
Objective - The aim of this study was to compare the outcomes of enucleation versus resection in patients with small pancreatic, ampullary, and duodenal neuroendocrine tumors (NETs). Methods - Multi-institutional retrospective review identified all patients with pancreatic and peri-pancreatic NETs who underwent surgery from January 1990 to October 2008. Patients with tumors ≤3 cm and without nodal or metastatic disease were included. Results - Of the 271 patients identified, 122 (45%) met the inclusion criteria and had either an enucleation (n=37) and/or a resection (n=87). Enucleated tumors were more likely to be in the pancreatic head (P=0.003) or functioning (P<0.0001) and, when applicable, less likely to result in splenectomy (P=0.0003). The rate of pancreatic fistula formation was higher after enucleation (P<0.01), but the fistula severity tended to be worse following resection (P=0.07). The enucleation and resection patients had similar operative times, blood loss, overall morbidity, mortality, hospital stay, and 5-year survival. However, for pancreatic head tumors, enucleation resulted in decreased blood loss, operative time, and length of stay compared to pancreaticoduodenectomy (P<0.05). Conclusion - These data suggest that most outcomes of enucleation and resection for small pancreatic and peri-pancreatic NETs are comparable. However, enucleation has better outcomes than pancreaticoduodenectomy for head lesions and the advantage of preserving splenic function for tail lesions.
| Original language | English |
|---|---|
| Pages (from-to) | 1692-1698 |
| Number of pages | 7 |
| Journal | Journal of Gastrointestinal Surgery |
| Volume | 13 |
| Issue number | 9 |
| DOIs | |
| State | Published - Aug 2009 |
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Keywords
- Ampulla of Vater
- Duodenum
- Islet cell tumor
- Neuroendocrine tumor
- Pancreas neoplasm
ASJC Scopus subject areas
- Surgery
- Gastroenterology
Cite this
Small pancreatic and periampullary neuroendocrine tumors : Resect or enucleate? / Pitt, Susan C.; Pitt, Henry A.; Baker, Marshall S.; Christians, Kathleen; Touzios, John G.; Kiely, James M.; Weber, Sharon M.; Wilson, Stuart D.; Howard, Thomas; Talamonti, Mark S.; Rikkers, Layton F.
In: Journal of Gastrointestinal Surgery, Vol. 13, No. 9, 08.2009, p. 1692-1698.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Small pancreatic and periampullary neuroendocrine tumors
T2 - Resect or enucleate?
AU - Pitt, Susan C.
AU - Pitt, Henry A.
AU - Baker, Marshall S.
AU - Christians, Kathleen
AU - Touzios, John G.
AU - Kiely, James M.
AU - Weber, Sharon M.
AU - Wilson, Stuart D.
AU - Howard, Thomas
AU - Talamonti, Mark S.
AU - Rikkers, Layton F.
PY - 2009/8
Y1 - 2009/8
N2 - Objective - The aim of this study was to compare the outcomes of enucleation versus resection in patients with small pancreatic, ampullary, and duodenal neuroendocrine tumors (NETs). Methods - Multi-institutional retrospective review identified all patients with pancreatic and peri-pancreatic NETs who underwent surgery from January 1990 to October 2008. Patients with tumors ≤3 cm and without nodal or metastatic disease were included. Results - Of the 271 patients identified, 122 (45%) met the inclusion criteria and had either an enucleation (n=37) and/or a resection (n=87). Enucleated tumors were more likely to be in the pancreatic head (P=0.003) or functioning (P<0.0001) and, when applicable, less likely to result in splenectomy (P=0.0003). The rate of pancreatic fistula formation was higher after enucleation (P<0.01), but the fistula severity tended to be worse following resection (P=0.07). The enucleation and resection patients had similar operative times, blood loss, overall morbidity, mortality, hospital stay, and 5-year survival. However, for pancreatic head tumors, enucleation resulted in decreased blood loss, operative time, and length of stay compared to pancreaticoduodenectomy (P<0.05). Conclusion - These data suggest that most outcomes of enucleation and resection for small pancreatic and peri-pancreatic NETs are comparable. However, enucleation has better outcomes than pancreaticoduodenectomy for head lesions and the advantage of preserving splenic function for tail lesions.
AB - Objective - The aim of this study was to compare the outcomes of enucleation versus resection in patients with small pancreatic, ampullary, and duodenal neuroendocrine tumors (NETs). Methods - Multi-institutional retrospective review identified all patients with pancreatic and peri-pancreatic NETs who underwent surgery from January 1990 to October 2008. Patients with tumors ≤3 cm and without nodal or metastatic disease were included. Results - Of the 271 patients identified, 122 (45%) met the inclusion criteria and had either an enucleation (n=37) and/or a resection (n=87). Enucleated tumors were more likely to be in the pancreatic head (P=0.003) or functioning (P<0.0001) and, when applicable, less likely to result in splenectomy (P=0.0003). The rate of pancreatic fistula formation was higher after enucleation (P<0.01), but the fistula severity tended to be worse following resection (P=0.07). The enucleation and resection patients had similar operative times, blood loss, overall morbidity, mortality, hospital stay, and 5-year survival. However, for pancreatic head tumors, enucleation resulted in decreased blood loss, operative time, and length of stay compared to pancreaticoduodenectomy (P<0.05). Conclusion - These data suggest that most outcomes of enucleation and resection for small pancreatic and peri-pancreatic NETs are comparable. However, enucleation has better outcomes than pancreaticoduodenectomy for head lesions and the advantage of preserving splenic function for tail lesions.
KW - Ampulla of Vater
KW - Duodenum
KW - Islet cell tumor
KW - Neuroendocrine tumor
KW - Pancreas neoplasm
UR - http://www.scopus.com/inward/record.url?scp=70349434733&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=70349434733&partnerID=8YFLogxK
U2 - 10.1007/s11605-009-0946-z
DO - 10.1007/s11605-009-0946-z
M3 - Article
VL - 13
SP - 1692
EP - 1698
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
SN - 1091-255X
IS - 9
ER -