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Observation versus Resection for Small Asymptomatic Pancreatic Neuroendocrine Tumors: A Matched Case–Control Study

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objective

To analyze the natural history of small asymptomatic pancreatic neuroendocrine tumors (PanNET) and to present a matched comparison between groups who underwent either initial observation or resection. Management approach for small PanNET is uncertain.

Methods

Incidentally discovered, sporadic, small (<3 cm), stage I–II PanNET were analyzed retrospectively between 1993 and 2013. Diagnosis was determined either by pathology or imaging characteristics. Intention-to-treat analysis was applied.

Results

A total of 464 patients were reviewed. Observation was recommended for 104 patients (observation group), and these patients were matched to 77 patients in the resection group based on tumor size at initial imaging. The observation group was significantly older (median 63 vs. 59 years, p = 0.04) and tended towards shorter follow-up (44 vs. 57 months, p = 0.06). Within the observation group, 26 of the 104 patients (25 %) underwent subsequent tumor resection after a median observation interval of 30 months (range 7–135). At the time of last follow-up of the observation group, the median tumor size had not changed (1.2 cm, p = 0.7), and no patient had developed evidence of metastases. Within the resection group, low-grade (G1) pathology was recorded in 72 (95 %) tumors and 5 (6 %) developed a recurrence, which occurred after a median of 5.1 (range 2.9–8.1) years. No patient in either group died from disease. Death from other causes occurred in 11 of 181 (6 %) patients.

Conclusions

In this study, no patient who was initially observed developed metastases or died from disease after a median follow-up of 44 months. Observation for stable, small, incidentally discovered PanNET is reasonable in selected patients.

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Acknowledgements

Funded in part by the NIH/NCI Cancer Center Support Grant P30 CA008748, R21-CA158267.

Disclosure

All authors declare that they have no conflict of interest regarding this study.

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Authors and Affiliations

  1. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Eran Sadot MD, Michael I. D’Angelica MD, Ronald P. DeMatteo MD, T. Peter Kingham MD, Bas Groot Koerkamp MD, Brian R. Untch MD, Murray F. Brennan MD, William R. Jarnagin MD & Peter J. Allen MD

  2. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Diane L. Reidy-Lagunes MD

  3. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Laura H. Tang MD, PhD

  4. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Richard Kinh Gian Do MD, PhD

  5. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Mithat Gonen PhD

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  1. Eran Sadot MD
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  2. Diane L. Reidy-Lagunes MD
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  3. Laura H. Tang MD, PhD
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  4. Richard Kinh Gian Do MD, PhD
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  6. Michael I. D’Angelica MD
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  7. Ronald P. DeMatteo MD
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  13. Peter J. Allen MD
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Corresponding author

Correspondence to Peter J. Allen MD.

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Sadot, E., Reidy-Lagunes, D.L., Tang, L.H. et al. Observation versus Resection for Small Asymptomatic Pancreatic Neuroendocrine Tumors: A Matched Case–Control Study. Ann Surg Oncol 23, 1361–1370 (2016). https://doi.org/10.1245/s10434-015-4986-1

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  • DOI: https://doi.org/10.1245/s10434-015-4986-1

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