Small pancreatic and periampullary neuroendocrine tumors: Resect or enucleate?

Susan C. Pitt, Henry A. Pitt, Marshall S. Baker, Kathleen Christians, John G. Touzios, James M. Kiely, Sharon M. Weber, Stuart D. Wilson, Thomas Howard, Mark S. Talamonti, Layton F. Rikkers

Research output: Contribution to journalArticle

78 Citations (Scopus)

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 languageEnglish
Pages (from-to)1692-1698
Number of pages7
JournalJournal of Gastrointestinal Surgery
Volume13
Issue number9
DOIs
StatePublished - Aug 2009

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Neuroendocrine Tumors
Pancreaticoduodenectomy
Operative Time
Length of Stay
Pancreatic Fistula
Neoplasms
Splenectomy
Fistula
Head
Morbidity
Survival
Mortality

Keywords

  • Ampulla of Vater
  • Duodenum
  • Islet cell tumor
  • Neuroendocrine tumor
  • Pancreas neoplasm

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Pitt, S. C., Pitt, H. A., Baker, M. S., Christians, K., Touzios, J. G., Kiely, J. M., ... Rikkers, L. F. (2009). Small pancreatic and periampullary neuroendocrine tumors: Resect or enucleate? Journal of Gastrointestinal Surgery, 13(9), 1692-1698. https://doi.org/10.1007/s11605-009-0946-z

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 journalArticle

Pitt, SC, Pitt, HA, Baker, MS, Christians, K, Touzios, JG, Kiely, JM, Weber, SM, Wilson, SD, Howard, T, Talamonti, MS & Rikkers, LF 2009, 'Small pancreatic and periampullary neuroendocrine tumors: Resect or enucleate?', Journal of Gastrointestinal Surgery, vol. 13, no. 9, pp. 1692-1698. https://doi.org/10.1007/s11605-009-0946-z
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. / Small pancreatic and periampullary neuroendocrine tumors : Resect or enucleate?. In: Journal of Gastrointestinal Surgery. 2009 ; Vol. 13, No. 9. pp. 1692-1698.
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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.",
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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.

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