World Journal of Surgery

, Volume 24, Issue 11, pp 1353–1360

Surgical Strategy for Large or Malignant Endocrine Pancreatic Tumors

  • Per Hellman
  • Maria Andersson
  • Jonas Rastad
  • Claes Juhlin
  • Sadettin Karacagil
  • Barbro Eriksson
  • Britt Skogseid
  • Göran Åkerström
Article

DOI: 10.1007/s002680010224

Cite this article as:
Hellman, P., Andersson, M., Rastad, J. et al. World J. Surg. (2000) 24: 1353. doi:10.1007/s002680010224

Abstract

Endocrine pancreatic tumors (EPTs) are rare but have a remarkably better prognosis than adenocarcinoma of the pancreas. Patients with EPTs benefit from surgical and medical therapy, which may alleviate symptoms due to hormonal excess and increase survival. Patients with large or malignant EPTs with infiltrative disease may suffer from local complications, including gastrointestinal bleeding and obstruction and involvement of the superior mesenteric (SMV) and portal (PV) veins. Among 31 patients with operable and large or malignant EPTs, 7 had hormone-producing syndromes (insulin, glucagon), and 24 had clinically nonfunctioning EPTs. Surgery in these patients included vascular reconstruction of the SMV/PV (n= 4), resection of infiltrated adjacent organs (n= 5; stomach, transverse colon), or resection of concomitant liver metastases (n= 3). Four patients with conspicuously large insulinomas, and three with glucagonoma were successfully operated on with alleviation of hormonal symptoms. Among the 24 nonfunctioning EPTs, 5 patients had been explored earlier and their tumors judged inoperable due to locally invasive disease or misdiagnosis as pancreatic adenocarcinoma. The operations were performed with no mortality and low morbidity. We conclude that large and malignant EPTs with limited spread of disease may benefit from a combination of medical and surgical therapy.

Copyright information

© Société Internationale de Chirurgie 2000

Authors and Affiliations

  • Per Hellman
    • 1
  • Maria Andersson
    • 1
  • Jonas Rastad
    • 1
  • Claes Juhlin
    • 1
  • Sadettin Karacagil
    • 1
  • Barbro Eriksson
    • 2
  • Britt Skogseid
    • 2
  • Göran Åkerström
    • 1
  1. 1.Department of Surgery, University Hospital, S-751 85 Uppsala, SwedenSE
  2. 2.Department of Internal Medicine, University Hospital, S-751 85 Uppsala, SwedenSE