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Outcomes of Pancreaticoduodenectomy for Pancreatic Neuroendocrine Tumors: Are Combined Procedures Justified?

  • 2015 SSAT Poster Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Efficacy and outcomes of resection for pancreatic neuroendocrine tumors (pNET) are well established; specific data on outcomes for pancreaticoduodenectomy (PD), either alone or with combined procedures, are limited. A retrospective review of PDs for pNET (1998–2014) at our institution was conducted. Patients were categorized into standard PD (SPD) alone or combined PD (CPD) defined as patients undergoing concurrent vascular reconstruction or additional organ resection for curative intent. Kaplan-Meier survival analyses were performed. PD for pNET was performed for 95 patients. Tumors were functional in 11 patients (9 %). Twenty-six patients (28 %) underwent CPD. The 30/90-day mortality was 1.1/5.3 % respectively and similar between SPD and CPD (p = 0.61/p = 0.24). Five-year overall survival after PD for pNET was 85.1/71.9 % and similar between SPD/CPD groups (p = 0.17). Recurrence-free and overall survival for low-grade tumors was 74.7/93.9 % at 5 years compared to only 14.8/49.7 % for high-grade tumors (p < 0.001) and not predicted by extent of resection (SPD/CPD, respectively). PD with or without concurrent resection provides an acceptable, perioperative and long-term oncologic, outcome for pNET. CPD is justified treatment modality, particularly for patients with low-grade tumors. The need for combinatorial procedures during PD is not contraindication alone for otherwise resectable patients with pNET.

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References

  1. Halfdanarson TR, Rabe KG, Rubin J, Petersen GM. Pancreatic neuroendocrine tumors (PNETs): incidence, prognosis and recent trend toward improved survival. Ann Oncol 2008;19(10):1727-1733.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Imtiaz KE, Monteith P, Khaleeli A. Complete histological regression of metastatic carcinoid tumour after treatment with octreotide. Clin Endocrinol (Oxf) 2000;53(6):755-758.

    Article  CAS  Google Scholar 

  3. Shojamanesh H, Gibril F, Louie A, Ojeaburu J, Bashir S, Abour-Saif A, Jensen RT. Prospective study of the antitumor efficacy of long-term octreotide treatment in patients with progressive metastatic gastrinoma. Cancer 2002;94(2):331-343.

    Article  CAS  PubMed  Google Scholar 

  4. Arnold R, Simon B, Wied M. Treatment of neuroendocrine GEP tumours with somatostatin analogues: a review. Digestion 2000;62 Suppl 1:84-91.

    Article  CAS  PubMed  Google Scholar 

  5. 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(4):741-751.

    Article  PubMed  Google Scholar 

  6. Norton JA, Doherty GM, Fraker DL, Alexander HR, Doppman JL, Gibril F, Jensen RT. Surgical treatment of localized gastrinoma within the liver: A prospective study. Surgery 1998;124(6):1145-1152.

    Article  CAS  PubMed  Google Scholar 

  7. Mauriello C, Napolitano S, Gambardella C, Candela G, De Vita F, Orditura M, Sciascia V, Tartaglia E, Lanza M, Luigi S, Conzo G. Conservative management and parenchyma-sparing resections of pancreatic neuroendocrine tumors: Literature review. Int J Surg 2015;21 Suppl 1:S10-S14.

    Article  PubMed  Google Scholar 

  8. Norton JA, Kivlen M, Li M, Schneider D, Chuter T, Jensen RT. Morbidity and mortality of aggressive resection in patients with advanced neuroendocrine tumors. Arch Surg 2003;138(8):859-866.

    Article  PubMed  Google Scholar 

  9. Krampitz GW, Norton JA, Poultsides GA, Visser BC, Sun L, Jensen RT. Lymph Nodes and Survival in Pancreatic Neuroendocrine Tumors. Arch Surg 2012;147(9):820.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Smith JK, Ng SC, Hill JS, Simmons JP. Shah SA, Tseng JF, McDade TP. Complications after pancreatectomy for neuroendocrine tumors: a national study. J Surg Res 2010;163(1):63-68.

    Article  PubMed  Google Scholar 

  11. Shimada K, Sano T, Sakamoto Y, Kosuge T. Clinical implications of combined portal vein resection as a palliative procedure in patients undergoing pancreaticoduodenectomy for pancreatic head carcinoma. Ann Surg Oncol 2006;13(12):1569-1578.

    Article  PubMed  Google Scholar 

  12. Zhou Y, Zhang Z, Liu Y, Li B, Xu D. Pancreatectomy combined with superior mesenteric vein-portal vein resection for pancreatic cancer: a meta-analysis. World J Surg 2012;36(4):884-891.

    Article  PubMed  Google Scholar 

  13. Bachellier P, Nakano H, Oussoultzoglou PD, Weber JC, Boudjema K, Wolf PD, Jaeck D. Is pancreaticoduodenectomy with mesentericoportal venous resection safe and worthwhile? Am J Surg 2001;182(2):120-129.

    Article  CAS  PubMed  Google Scholar 

  14. Leach SD, Lee JE, Charnsangavej C, Cleary KR, Lowy AM, Fenoglio CJ, Pisters PWT, Evans DB. Survival following pancreaticoduodenectomy with resection of the superior mesenteric-portal vein confluence for adenocarcinoma of the pancreatic head. Br J Surg 1998;85(5):611-617.

    Article  CAS  PubMed  Google Scholar 

  15. Müller SA, Hartel M, Mehrabi A, Welsch T, Martin DJ, Hinz U, Schmied BM, Büchler MW . Vascular resection in pancreatic cancer surgery: survival determinants. J Gastrointest Surg 2009;13(4):784-792.

    Article  PubMed  Google Scholar 

  16. Kaneoka Y, Yamaguchi A, Isogai M. Portal or superior mesenteric vein resection for pancreatic head adenocarcinoma: prognostic value of the length of venous resection. Surgery 2009;145(4):417-425.

    Article  PubMed  Google Scholar 

  17. Croome KP, Farnell MB, Que FG, Reid-Lombardo KM, Truty MJ, Nagorney DM, Kendrick ML. Pancreaticoduodenectomy with major vascular resection: a comparison of laparoscopic versus open approaches. J Gastrointest Surg 2015;19(1):189-19.

    Article  PubMed  Google Scholar 

  18. Chamberlain RS, Canes D, Brown KT, Saltz L, Jarnagin W, Fong Y, Blumgart LH. Hepatic neuroendocrine metastases: does intervention alter outcomes? J Am Coll Surg 2000;190(4):432-445.

    Article  CAS  PubMed  Google Scholar 

  19. Sarmiento JM, Heywood G, Rubin J, Ilstrup DM, Nagorney DM, Que FG. Surgical treatment of neuroendocrine metastases to the liver. J Am Coll Sur. 2003;197(1):29-37.

    Article  Google Scholar 

  20. Sarmiento JM, Que FG. Hepatic surgery for metastases from neuroendocrine tumors. Surg Oncol Clin N Am 2003;12(1):231-242.

    Article  PubMed  Google Scholar 

  21. Solorzano CC, Lee JE, Pisters PWT, Vauthey JN, Ayers GD, Jean ME, Gagel RF, Ajani JA, Walff RA, Evans DB. Nonfunctioning islet cell carcinoma of the pancreas: Survival results in a contemporary series of 163 patients. Surgery 2001;130(6):1078-1085.

    Article  CAS  PubMed  Google Scholar 

  22. Rindi G, Klöppel G, Alhman H, Caplin M, Couvelard A, de Herder WW, Erikssson B, Falchetti A, Falconi M, 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(4):395-401.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. 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(1):8-13.

    Article  PubMed  Google Scholar 

  24. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992;45(6):613-619.

    Article  CAS  PubMed  Google Scholar 

  25. Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240(2):205-213.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Norton JA, Warren RS, Kelly MG, Zuraek MB, Jensen RT. Aggressive surgery for metastatic liver neuroendocrine tumors. Surgery 2003;134(6):1057-1065.

    Article  PubMed  Google Scholar 

  27. Shubert CR, Kendrick ML, Thomsen KM, Farnell MB, Habermann EB. Identification of risk categories for in pancreaticoduodenectomy based on diagnosis. HPB (Oxford) 2015;17(5):428-437.

    Article  Google Scholar 

  28. Tsutsumi K, Ohtsuka T, Fujino M, Nakashima H, Aishima S, Ueda J, Takahata S, Nakamura M, Oda Y, Tanaka M. Analysis of risk factors for recurrence after curative resection of well-differentiated pancreatic neuroendocrine tumors based on the new grading classification. J Hepatobiliary Pancreat Sci 2014;21(6):418-425.

    Article  PubMed  Google Scholar 

  29. Boninsegna L, Panzuto F, Partelli S, Capelli P, Delle Fave G, Bettini R, Pederzoli P, Scarpa A, Falconi M. Malignant pancreatic neuroendocrine tumour: lymph node ratio and Ki67 are predictors of recurrence after curative resections. Eur J Cancer 2012;48(11):1608-1615.

    Article  PubMed  Google Scholar 

  30. Kroneman TN, Voss JS, Lohse CM, Wu T-T, Smyrk TC, Zhang L. Comparison of Three Ki-67 Index Quantification Methods and Clinical Significance in Pancreatic Neuroendocrine Tumors. Endocr Pathol 2015;26(3):255-262.

    Article  CAS  PubMed  Google Scholar 

  31. Gouma DJ, van Geenen RC, van Gulik TM, de Haan RJ, de Wit LT, Busch OR, Obertop H. Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg 2000;232:786-795.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Hackert T, Werner J, Büchler MW. Postoperative pancreatic fistula. Surgeon 2011;9(4):211-217.

    Article  PubMed  Google Scholar 

  33. Epelboym I, Gawlas I, Lee JA, Schrope B, Chabot JA, Allendorf JD. Limitations of ACS-NSQIP in reporting complications for patients undergoing pancreatectomy: underscoring the need for a pancreas-specific module. World J Surg 2014;38(6):1461-1467.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic Rochester, 200 First St. Southwest, Rochester, MN, 55905, USA

    Cornelius A. Thiels, John R. Bergquist, Danuel V. Laan, Rory L. Smoot, David M. Nagorney, Geoffrey B. Thompson, Michael L. Kendrick, Michael B. Farnell & Mark J. Truty

  2. Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA

    Cornelius A. Thiels & John R. Bergquist

  3. Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA

    Kristopher P. Croome

Authors
  1. Cornelius A. Thiels
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  2. John R. Bergquist
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  3. Danuel V. Laan
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  4. Kristopher P. Croome
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  5. Rory L. Smoot
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  6. David M. Nagorney
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  7. Geoffrey B. Thompson
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  8. Michael L. Kendrick
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  9. Michael B. Farnell
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  10. Mark J. Truty
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Corresponding author

Correspondence to Mark J. Truty.

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Grant Support

This study is supported by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

Additional information

The work was presented as a poster of distinction at the 49th Annual Pancreas Club meeting and SSAT’s 56th Annual Meeting during Digestive Disease Week in May 2015 in Washington, DC.

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Thiels, C.A., Bergquist, J.R., Laan, D.V. et al. Outcomes of Pancreaticoduodenectomy for Pancreatic Neuroendocrine Tumors: Are Combined Procedures Justified?. J Gastrointest Surg 20, 891–898 (2016). https://doi.org/10.1007/s11605-016-3102-6

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  • DOI: https://doi.org/10.1007/s11605-016-3102-6

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