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Parenchyma-Sparing Resections for Pancreatic Neuroendocrine Tumors

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Journal of Gastrointestinal Surgery Aims and scope

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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Conflict of Interest

None of the authors have any financial or any other kind of personal conflicts of interest.

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Authors and Affiliations

  1. Department of Hepato–Pancreato–Biliary Surgery, Pôle des Maladies de l’Appareil Digestif (PMAD), AP-HP, hôpital Beaujon, 100, Bd du Général Leclerc, Clichy, 92110, France

    Rim Cherif, Sébastien Gaujoux, Safi Dokmak, Jacques Belghiti & Alain Sauvanet

  2. Université Paris Diderot, Paris, France

    Sébastien Gaujoux, Anne Couvelard, Marie-Pierre Vuillerme, Philippe Ruszniewski, Jacques Belghiti & Alain Sauvanet

  3. Département of Pathology, AP-HP, hôpital Beaujon, Clichy, 92110, France

    Anne Couvelard

  4. Department of Radiology, AP-HP, hôpital Beaujon, Clichy, 92110, France

    Marie-Pierre Vuillerme

  5. Department of Gastroenterology, Pôle des Maladies de l’Appareil Digestif (PMAD), AP-HP, hôpital Beaujon, Clichy, 92110, France

    Philippe Ruszniewski

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  1. Rim Cherif
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  8. Alain Sauvanet
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Corresponding author

Correspondence to Alain Sauvanet.

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Rim Cherif and Sébastien Gaujoux contributed equally to the work.

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Supplemental data 1

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

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