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Surgical Endoscopy

, Volume 31, Issue 10, pp 3847–3857 | Cite as

Short- and long-term outcomes of laparoscopic organ-sparing resection in pancreatic neuroendocrine tumors: a single-center experience

  • Javier A. Cienfuegos
  • Joseba Salguero
  • Jorge M. Núñez-Córdoba
  • Miguel Ruiz-Canela
  • Alberto Benito
  • Sira Ocaña
  • Gabriel Zozaya
  • Pablo Martí-Cruchaga
  • Fernando Pardo
  • José Luis Hernández-Lizoáin
  • Fernando RotellarEmail author
Article

Abstract

Background

Laparoscopic organ-sparing pancreatectomy (LOSP) is an ideal therapeutic option in selected cases of pancreatic neuroendocrine tumors (PNETs). Nevertheless, given the low frequency of PNETs, there is scarce evidence regarding short and particularly long-term outcomes of LOSP in this clinical setting.

Methods

All patients with PNETs who underwent surgery (under a LOSP policy) were retrospectively reviewed from a prospective database maintained at our center. Preoperative characteristics, operative data, pathological features and postoperative outcomes were analyzed.

Results

Between December 2003 and December 2015, 36 patients with PNETs underwent laparoscopic resections. Ten were functional tumors, 26 non-functional and 16 were “incidental” cases. The following procedures were performed: one enucleation, eight central pancreatectomies (LCP), one resection of the uncinate process and 26 distal pancreatectomies (DP) (15 of them laparoscopic vessels-preserving). There were no conversions to open surgery, and no drains were routinely left. Mean operative time was 288 min (SD 99). Hospital stay was 6 days. Eighteen patients (50%) experienced some complication of which most were mild (Clavien–Dindo I/II). Three postoperative bleedings occurred: two grade B/one grade C; two required laparoscopic reoperation. Thirteen (36.1%) patients developed peripancreatic fluid collections: two were symptomatic and were managed with transgastric drainage (one presented post-puncture abscesification requiring surgical drainage and splenectomy). Four patients (11%)—one DP and three LCP—developed new-onset pancreatogenic diabetes mellitus (NODM) in the long term. According to the European Neuroendocrine Tumor Society, 19 cases were stage I, seven IIA, two IIIA, one IIIB and seven stage IV. Over a mean follow-up of 51 months, two patients died, one due to recurrence of the tumor and another due to cirrhosis.

Conclusions

The existing different surgical options must be individually considered according to the location and particular characteristics of every tumor. Results from this single-center study document the effectiveness of LOSP in selected cases of PNETs.

Keywords

Organ-sparing pancreatectomy Organ-saving surgery Neuroendocrine tumor Pancreas Laparoscopy 

Abbreviations

PNETs

Pancreatic neuroendocrine tumors

LOSP

Laparoscopic organ-sparing pancreatectomy

LCP

Laparoscopic central pancreatectomy

DP

Distal pancreatectomy

LVPDP

Laparoscopic vessels-preserving distal pancreatectomy

NODM

New-onset pancreatogenic diabetes mellitus

LEN

Enucleation

LDP

Laparoscopic distal pancreatectomy

WD

Wirsung duct

LRDPS

Laparoscopic radical distal pancreatosplenectomy

RAMPS

Radical anterograde modular pancreatosplenectomy

SD

Standard deviation

CT

Multislice computer tomography

MRI

Magnetic resonance imaging

EUS

Endoscopic ultrasound

ENETS

European neuroendocrine society

FNA

Fine-needle aspiration

BMI

Body mass index

Notes

Acknowledgements

The authors are grateful to Paul Miller Ph.D. for his help with the English and Lydia Munárriz for transcribing the manuscript.

Compliance with ethical standards

Disclosures

Javier A. Cienfuegos, Joseba Salguero, Núñez-Córdoba Jorge M, Miguel Ruiz-Canela, Alberto Benito, Sira Ocaña, Gabriel Zozaya, Pablo Martí-Cruchaga, Fernando Pardo, José Luis Hernández-Lizoáin and Fernando Rotellar have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Javier A. Cienfuegos
    • 1
    • 5
  • Joseba Salguero
    • 1
    • 5
  • Jorge M. Núñez-Córdoba
    • 2
    • 3
    • 5
  • Miguel Ruiz-Canela
    • 3
    • 5
  • Alberto Benito
    • 4
    • 5
  • Sira Ocaña
    • 1
    • 5
  • Gabriel Zozaya
    • 1
    • 5
  • Pablo Martí-Cruchaga
    • 1
    • 5
  • Fernando Pardo
    • 1
    • 5
  • José Luis Hernández-Lizoáin
    • 1
    • 5
  • Fernando Rotellar
    • 1
    • 5
    Email author
  1. 1.Department of General Surgery, Clínica Universidad de Navarra, School of MedicineUniversity of NavarraPamplonaSpain
  2. 2.Central Clinical Trials Unit, Research Support ServiceClínica Universidad de NavarraPamplonaSpain
  3. 3.Department of Preventive Medicine and Public Health, Medical SchoolUniversity of NavarraPamplonaSpain
  4. 4.Abdominal Radiology, Department of Radiology, Clínica Universidad de Navarra, School of MedicineUniversity of NavarraPamplonaSpain
  5. 5.Instituto de Investigación Sanitaria de Navarra (IdiSNA)PamplonaSpain

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