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Therapeutic Strategies for Advanced Pancreatic Neuroendocrine Tumors with Segmental Portal Hypertension

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Abstract

Background

Pancreatic neuroendocrine tumors (PNET) locally advanced may lead to significant local symptoms especially segmental portal hypertension (SPH) with risk of bleeding. The aim of our study was to evaluate the role of SPH on the PNET management in an expert center.

Methods

Forty-two patients treated for locally advanced PNET with SPH between January 1984 and December 2012 were retrospectively analyzed.

Results

The median age was 55 years (25–75). The median tumor size was 7.5 cm (3–20). Thirty four (80.9 %) patients were metastatic mainly in the liver (n = 33, 79 %) with a frequent (n = 16, 38.1 %) involvement >20 %. The surgery was impossible because of SPH in 7 (16.6 %) cases. Pancreatic resection was performed in 28 (66.7 %) cases by distal pancreatectomy. Neoadjuvant chemotherapy (n = 24, 57 %) had no impact on SPH with no modification of collateral circulation. Among operated on patients, complete macroscopic resection was obtained in 19 (67.8 %) patients. The mortality and severe morbidity rate was respectively 3.6 and 18 %. Five year overall survival (OS) was similar in operated and no operated patients. (61 %; p = 0.64). The 5-year OS was 77.9 or 55.4 % in patients who underwent a complete or incomplete macroscopic resection of primary and metastases, respectively.

Conclusion

PNET resection associated with SPH is feasible with a low morbimortality. SPH was not improved by chemotherapy. Prolonged survival was observed after complete macroscopic resection.

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Acknowledgments

The authors acknowledge Pr Antonio Sa Cunha (Paul Brousse Hospital—Paris XI University—Villejuif—France).

Conflict of interest

The authors have no conflicts of interest and source of funding. The subject of study had no commercial interest, no financial or material support.

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Authors and Affiliations

  1. Department of Surgical Oncology, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France

    F. Dumont, Y. Goudard, D. Goéré & D. Elias

  2. Department of Radiology, Gustave Roussy Cancer Campus, Villejuif, France

    C. Caramella

  3. Department of Endocrinology, Gustave Roussy Cancer Campus, Villejuif, France

    E. Baudin

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  1. F. Dumont
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  2. Y. Goudard
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  3. C. Caramella
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  4. D. Goéré
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  5. E. Baudin
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  6. D. Elias
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Correspondence to F. Dumont.

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Dumont, F., Goudard, Y., Caramella, C. et al. Therapeutic Strategies for Advanced Pancreatic Neuroendocrine Tumors with Segmental Portal Hypertension. World J Surg 39, 1974–1980 (2015). https://doi.org/10.1007/s00268-015-3030-8

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  • DOI: https://doi.org/10.1007/s00268-015-3030-8

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