Abstract
Background
Parenchyma-sparing pancreatectomy (PSP), including enucleation and central pancreatectomy, has been investigated as an alternative to standard resection for pancreatic endocrine neoplasm, but the benefit/risk of these procedures remains little known.
Methods
From 1998 to 2010, among 197 patients operated for well-differentiated pancreatic neuroendocrine tumors, 67 underwent PSP (45 enucleations and 22 central pancreatectomies) and 66 standard resections (35 pancreaticoduodenectomies and 31 distal pancreatectomies) for a tumor below 4 cm, without synchronous distant metastasis. Groups were compared regarding postoperative morbidity, mortality, long-term pancreatic function, and survival calculated using the Kaplan–Meier method.
Results
Tumors operated by PSP had a median size of 15 mm, were mainly incidentally diagnosed (n = 46, 69 %), and nonfunctioning (n = 55, 82 %). Overall morbidity rate was higher after PSP than standard resection (SR) (76 vs 58 %, p = 0.0028), including more frequent pancreatic fistulas (69 vs 42 %, p = 0.003). Postoperative diabetes was less frequent following PSP than pancreaticoduodenectomy (5 vs 21 %; p = 0.022) but equivalent to the one observed after distal pancreatectomy (4 %, p = 1). Exocrine insufficiency was significantly less frequent after PSP than SR (3 vs 32 %; p < 0.0001). The overall and recurrence-free 5-year survival after PSP for nonfunctioning tumors was 96 and 98 %, respectively.
Conclusion
In selected patients, with small and low-grade tumors, PSP are associated with excellent overall and recurrence-free survivals. These procedures are associated with an increased postoperative morbidity but an excellent postoperative pancreatic function. Therefore, they should be considered as a valid therapeutic option in selected well-differentiated pancreatic neuroendocrine tumors.
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Abbreviations
- ASA:
-
American Society of Anaesthesiology
- BMI:
-
Body Mass Index
- CP:
-
Central Pancreatectomy
- EN:
-
Enucleation
- ENETS:
-
European Neuroendocrine Tumor Society
- ISGPS:
-
International Study Group on Pancreatic Surgery
- PNET:
-
Pancreatic NeuroEndocrine Tumors
- PSP:
-
Parenchyma-Sparing Pancreatectomy
- SR:
-
Standard Resection
- TNM:
-
Tumor Node Metastasis staging system
- UICC:
-
Union Internationale Contre le Cancer
- WDNET:
-
Well-Differentiated neuroendocrine Tumor
- WHO:
-
World Health Organization
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Rim Cherif and Sébastien Gaujoux contributed equally to the work.
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Number of node-positive patients (excluding all patients with Nx status) and WHO grade distribution according to size and secreting status (DOC 38 kb)
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Cherif, R., Gaujoux, S., Couvelard, A. et al. Parenchyma-Sparing Resections for Pancreatic Neuroendocrine Tumors. J Gastrointest Surg 16, 2045–2055 (2012). https://doi.org/10.1007/s11605-012-2002-7
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DOI: https://doi.org/10.1007/s11605-012-2002-7