Advertisement

Journal of Gastrointestinal Surgery

, Volume 14, Issue 10, pp 1536–1546 | Cite as

One Hundred Thirty Resections for Pancreatic Neuroendocrine Tumor: Evaluating the Impact of Minimally Invasive and Parenchyma-Sparing Techniques

  • Joseph DiNorcia
  • Minna K. Lee
  • Patrick L. Reavey
  • Jeanine M. Genkinger
  • James A. Lee
  • Beth A. Schrope
  • John A. Chabot
  • John D. Allendorf
2010 SSAT Plenary Presentation

Abstract

Background

Increasingly, surgeons apply minimally invasive and parenchyma-sparing techniques to the management of pancreatic neuroendocrine tumor (PNET). The aim of this study was to evaluate the impact of these approaches on patient outcomes.

Methods

We retrospectively collected data on patients with PNET and compared perioperative and pathologic variables. Survival was analyzed using the Kaplan–Meier method. Factors influencing survival were evaluated using a Cox proportional hazards model.

Results

One hundred thirty patients underwent resection for PNET. Traditional resections included 43 pancreaticoduodenectomies (PD), 38 open distal pancreatectomies (DP), and four total pancreatectomies. Minimally invasive and parenchyma-sparing resections included 25 laparoscopic DP, 11 central pancreatectomies, five enucleations, three partial pancreatectomies, and one laparoscopic-assisted PD. Compared to traditional resections, the minimally invasive and parenchyma-sparing resections had shorter hospital stays. By univariate analysis of neuroendocrine carcinoma, liver metastases and positive resection margins correlated with poor survival. There was an increase in minimally invasive or parenchyma-sparing resections over the study period with no differences in morbidity, mortality, or survival.

Conclusion

In this series, there has been a significant increase in minimally invasive and parenchyma-sparing techniques for PNET. This shift did not increase morbidity or compromise survival. In addition, minimally invasive and parenchyma-sparing operations yielded shorter hospital stays.

Keywords

Pancreatic neuroendocrine tumor Pancreatectomy Minimally invasive Laparoscopic Parenchyma-sparing resection 

Notes

Acknowledgements

This work was supported by the I.W. Foundation, The Doris Duke Charitable Foundation, and an institutional Ruth L. Kirschstein National Research Service Award (T32 HL 007854-14).

References

  1. 1.
    Halfdanarson TR, Rabe KG, Rubin J, Petersen GM. Pancreatic neuroendocrine tumor (PNETs): incidence, prognosis and recent trend toward improved survival. Ann Oncol 2008;19:1727–1733.CrossRefPubMedGoogle Scholar
  2. 2.
    Halfdanarson TR, Rubin J, Farnell MB, Grant CS, Petersen GM. Pancreatic endocrine neoplasms: epidemiology and prognosis of pancreatic endocrine tumors. Endocr Relat Cancer 2008;15:409–427.CrossRefPubMedGoogle Scholar
  3. 3.
    Hill JS, McPhee JT, McDade TP, Zhou Z, Sullivan ME, Whalen GF, Tseng JF. Pancreatic neuroendocrine tumors: the impact of surgical resection on survival. Cancer 2009;115:741–751.CrossRefPubMedGoogle Scholar
  4. 4.
    Bilimoria KY, Tomlinson JS, Merkow RP, Stewart AK, Ko CY, Talamonti MS, Bentrem DJ. Clinicopathologic features and treatment trends of pancreatic neuroendocrine tumors: analysis of 9,821 patients. J Gastrointest Surg 2007;11:1460–1469.CrossRefPubMedGoogle Scholar
  5. 5.
    Bilimoria KY, Talamonti MS, Tomlinson JS, Stewart AK, Winchester DP, Ko CY, Bentrem DJ. Prognostic score predicting survival after resection of pancreatic neuroendocrine tumors: analysis of 3851 patients. Ann Surg 2008;247:490–500.CrossRefPubMedGoogle Scholar
  6. 6.
    Nissen NN, Kim AS, Yu R, Wolin EM, Friedman ML, Lo SK, Wachsman AM, Colquhoun SD. Pancreatic neuroendocrine tumors: presentation, management, and outcomes. Am Surg 2009;10:1025–1029.Google Scholar
  7. 7.
    Scarpa A, Mantovani W, Capelli P, Beghelli S, Boninsegna L, Bettini R, Panzuto F, Pederzoli P, delle Fave G, Falconi M. Pancreatic endocrine tumors: improved TNM staging and histopathological grading permit a clinically efficient prognostic stratification of patients. Mod Pathol 2010;doi: 10.1038/modpathol.2010.58 PubMedGoogle Scholar
  8. 8.
    Kloppel G, Perren A, Heitz PU. The gastroenteropancreatic neuroendocrine cell system and its tumors: the WHO classification. Ann NY Acad Sci 2004;1014:13–27.CrossRefPubMedGoogle Scholar
  9. 9.
    Rindi G, Klöppel G, Alhman H, Caplin M, Couvelard A, de Herder WW, Eriksson B, Falchetti A, Falconi A, Komminoth P, Körner M, Lopes JM, McNicol AM, Nilsson O, Perren A, Scarpa A, Scoazec JY, Wiedenmann B. TNM staging of foregut (neuro)endocrine tumors: a consensus proposal including a grading system. Virchows Arch 2006;449:395–401.CrossRefPubMedGoogle Scholar
  10. 10.
    Ito H, Abramson M, Ito K, Swanson E, Cho N, Ruan DT, Swanson RS, Whang EE. Surgery and staging of pancreatic neuroendocrine tumors: a 14-year experience. J Gastrointest Surg 2010;14:891–898.CrossRefPubMedGoogle Scholar
  11. 11.
    Norton JA, Kivlen M, Li M, Scheider D, Chuter T, Jensen RT. Morbidity and mortality of aggressive resection in patients with advanced neuroendocrine tumors. Arch Surg 2003;138:859–865.CrossRefPubMedGoogle Scholar
  12. 12.
    Schurr PG, Strate T, Rese K, Kaifi JT, Reichelt U, Petri S, Kleinhans H, Yekebas EF, Izbicki JR. Aggressive surgery improves long-term survival in neuroendocrine pancreatic tumors: an institutional experience. Ann Surg 2007;245:271–281.CrossRefGoogle Scholar
  13. 13.
    Nguyen SQ, Angel LP, Divino CM, Schluender S, Warner RRP. Surgery in malignant pancreatic neuroendocrine tumors. J Surg Onc 2007;96:397–403.CrossRefPubMedGoogle Scholar
  14. 14.
    Nomura N, Fujii T, Kanazumi N, Takeda S, Nomoto S, Kasuya H, Sugimoto H, Yamada S, Nakao A. Nonfunctioning neuroendocrine pancreatic tumors: our experience and management. J Hepatobiliary Pancreat Surg 2009;16:639:647.CrossRefPubMedGoogle Scholar
  15. 15.
    Hilal MA, McPhail MJW, Zeidan BA, Jones CE, Johnson CD, Pearce NW. Aggressive multi-visceral pancreatic resections for locally advanced neuroendocrine tumours. Is it worth it? JOP 2009:10:276–279.PubMedGoogle Scholar
  16. 16.
    Franko J, Feng W, Yip L, Genovese E, Moser AJ. Non-functional neuroendocrine carcinoma of the pancreas: incidence, tumor biology, and outcomes in 2,158 patients. J Gastrointest Surg 2010;14:541–548.CrossRefPubMedGoogle Scholar
  17. 17.
    DeOliveira ML, Winter JM, Schafer M, Cunningham SC, Cameron JL, Yeo CJ, Clavien PA. Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 2006;244:931–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138:8–13.CrossRefPubMedGoogle Scholar
  19. 19.
    Dimou AT, Syrigos KN, Saif MW. Neuroendocrine tumors of the pancreas: what’s new. Highlights from the “2010 ASCO gastrointestinal cancers symposium.” JOP 2010;11:135–138.PubMedGoogle Scholar
  20. 20.
    Kazanjian KK, Reber HA, Hines OJ. Resection of pancreatic neuroendocrine tumors: results of 70 cases. Arch Surg 2006;141:765–770.CrossRefPubMedGoogle Scholar
  21. 21.
    Gagner M, Pomp A, Herrera MF. Early experience with laparoscopic resections of islet cell tumors. Surgery 1996;120:1051–1054.CrossRefPubMedGoogle Scholar
  22. 22.
    Briggs CD, Mann CD, Irving GRB, Neal CP, Peterson M, Cameron IC, Berry DP. Systematic review of minimally invasive pancreatic resection. J Gastrointest Surg 2009;13:1129–1137.CrossRefPubMedGoogle Scholar
  23. 23.
    Gumbs AA, Grès P, Madureira FA, Gayet B. Laparoscopic vs. open resection of noninvasive intraductal pancreatic mucinous neoplasms. J Gastrointest Surg 2008;12:707–712.CrossRefPubMedGoogle Scholar
  24. 24.
    Crippa S, Bassi C, Warshaw AL, Falconi M, Partelli S, Thayer SP, et al. Middle pancreatectomy: indications, short- and long-term operative outcomes. Ann Surg 2007;246:69–76.CrossRefPubMedGoogle Scholar
  25. 25.
    Allendorf JD, Schrope BA, Lauerman MH, Inabnet WB, Chabot JA. Postoperative glycemic control after central pancreatectomy for mid-gland lesions. World J Surg 2007;31:164–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Adham M, Giunippero A, Hervieu V, Courbiere M, Partensky C. Central pancreatectomy: a single-center experience of 50 cases. Arch Surg 2008;143:175–80.CrossRefPubMedGoogle Scholar
  27. 27.
    Crippa S, Boninsegna L, Partelli S, Falconi M. Parenchyma-sparing resections for pancreatic neoplasms. J Hepatobiliary Pancreat Surg 2009;doi: 10.1007/s00534-009-0224-1.Google Scholar
  28. 28.
    Falconi M, Zerbi A, Crippa S, Balzano G, Boninsegna L, Capitanio V, Bassi C, DiCarlo V, Pederzoli P. Parenchyma-preserving resections for small nonfunctioning pancreatic endocrine tumors. Ann Surg Oncol 2010;doi: 10.1245/s10434-010-0949-8.PubMedGoogle Scholar
  29. 29.
    Pitt SC, Pitt HA, Baker MS, Christians K, Touzios JG, Kiely JM, Weber SM, Wilson SD, Howard TJ, Talamonti MS, Rikkers LF. Small pancreatic and periampullary neuroendocrine tumors: resect or enucleate? J Gastrointest Surg 2009;13:1692–1698.CrossRefPubMedGoogle Scholar
  30. 30.
    Fernández-Cruz L, Blanco L, Cosa R, Rendón H. Is laparoscopic resection adequate in patients with neuroendocrine pancreatic tumors? World J Surg 2008;32:904–917.CrossRefPubMedGoogle Scholar
  31. 31.
    Kooby DA, Hawkins WG, Schmidt CM, Weber SM, Bentrem DJ, Gillespie TW, Sellers JB, Merchant NB, Scoggins CR, Martin RC 3rd, Kim HJ, Ahmad S, Cho CS, Parikh AA, Chu CK, Hamilton NA, Doyle CJ, Pinchot S, Hayman A, McClaine R, Nakeeb A, Staley CA, McMasters KM, Lillemoe KD. A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate? J Am Coll Surg 2010;210:779–785.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2010

Authors and Affiliations

  • Joseph DiNorcia
    • 1
  • Minna K. Lee
    • 1
  • Patrick L. Reavey
    • 1
  • Jeanine M. Genkinger
    • 2
  • James A. Lee
    • 1
  • Beth A. Schrope
    • 1
  • John A. Chabot
    • 1
  • John D. Allendorf
    • 1
  1. 1.College of Physicians and Surgeons, Department of SurgeryColumbia UniversityNew YorkUSA
  2. 2.Mailman School of Public Health, Department of EpidemiologyColumbia UniversityNew YorkUSA

Personalised recommendations