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Small Pancreatic and Periampullary Neuroendocrine Tumors: Resect or Enucleate?

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Objective

The aim of this study was to compare the outcomes of enucleation versus resection in patients with small pancreatic, ampullary, and duodenal neuroendocrine tumors (NETs).

Methods

Multi-institutional retrospective review identified all patients with pancreatic and peri-pancreatic NETs who underwent surgery from January 1990 to October 2008. Patients with tumors ≤3 cm and without nodal or metastatic disease were included.

Results

Of the 271 patients identified, 122 (45%) met the inclusion criteria and had either an enucleation (n = 37) and/or a resection (n = 87). Enucleated tumors were more likely to be in the pancreatic head (P = 0.003) or functioning (P < 0.0001) and, when applicable, less likely to result in splenectomy (P = 0.0003). The rate of pancreatic fistula formation was higher after enucleation (P < 0.01), but the fistula severity tended to be worse following resection (P = 0.07). The enucleation and resection patients had similar operative times, blood loss, overall morbidity, mortality, hospital stay, and 5-year survival. However, for pancreatic head tumors, enucleation resulted in decreased blood loss, operative time, and length of stay compared to pancreaticoduodenectomy (P < 0.05).

Conclusion

These data suggest that most outcomes of enucleation and resection for small pancreatic and peri-pancreatic NETs are comparable. However, enucleation has better outcomes than pancreaticoduodenectomy for head lesions and the advantage of preserving splenic function for tail lesions.

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Acknowledgements

This work was supported by the American College of Surgeons Resident Research Scholarship and NIH Grant T32 CA009614 Physician Scientist Training in Cancer Medicine.

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Authors and Affiliations

  1. Department of Surgery, Indiana University School of Medicine, 535 Barnhill Drive, RT130D, Indianapolis, IN, 46202-5124, USA

    Susan C. Pitt, Henry A. Pitt & Thomas J. Howard

  2. Department of Surgery, University of Wisconsin, Madison, WI, USA

    Susan C. Pitt, Sharon M. Weber & Layton F. Rikkers

  3. Department of Surgery, University of Chicago Pritzker School of Medicine, NorthShore Campus, Chicago, IL, USA

    Marshall S. Baker & Mark S. Talamonti

  4. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Kathleen Christians, John G. Touzios, James M. Kiely & Stuart D. Wilson

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  1. Susan C. Pitt
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  2. Henry A. Pitt
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  4. Kathleen Christians
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  8. Stuart D. Wilson
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  9. Thomas J. Howard
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Correspondence to Henry A. Pitt.

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American College of Surgeons Resident Research Scholarship, NIH Grant T32 CA009614 Physician Scientist Training in Cancer Medicine.

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Pitt, S.C., Pitt, H.A., Baker, M.S. et al. Small Pancreatic and Periampullary Neuroendocrine Tumors: Resect or Enucleate?. J Gastrointest Surg 13, 1692–1698 (2009). https://doi.org/10.1007/s11605-009-0946-z

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  • DOI: https://doi.org/10.1007/s11605-009-0946-z

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