Journal of Gastrointestinal Surgery

, Volume 13, Issue 9, pp 1692–1698

Small Pancreatic and Periampullary Neuroendocrine Tumors: Resect or Enucleate?

Authors

  • Susan C. Pitt
    • Department of SurgeryIndiana University School of Medicine
    • Department of SurgeryUniversity of Wisconsin
    • Department of SurgeryIndiana University School of Medicine
  • Marshall S. Baker
    • Department of SurgeryUniversity of Chicago Pritzker School of Medicine
  • Kathleen Christians
    • Department of SurgeryMedical College of Wisconsin
  • John G. Touzios
    • Department of SurgeryMedical College of Wisconsin
  • James M. Kiely
    • Department of SurgeryMedical College of Wisconsin
  • Sharon M. Weber
    • Department of SurgeryUniversity of Wisconsin
  • Stuart D. Wilson
    • Department of SurgeryMedical College of Wisconsin
  • Thomas J. Howard
    • Department of SurgeryIndiana University School of Medicine
  • Mark S. Talamonti
    • Department of SurgeryUniversity of Chicago Pritzker School of Medicine
  • Layton F. Rikkers
    • Department of SurgeryUniversity of Wisconsin
Original Article

DOI: 10.1007/s11605-009-0946-z

Cite this article as:
Pitt, S.C., Pitt, H.A., Baker, M.S. et al. J Gastrointest Surg (2009) 13: 1692. doi:10.1007/s11605-009-0946-z

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.

Keywords

Neuroendocrine tumorIslet cell tumorPancreas neoplasmAmpulla of VaterDuodenum

Copyright information

© The Society for Surgery of the Alimentary Tract 2009