Parenchyma-Preserving resections for small nonfunctioning pancreatic endocrine tumors

Massimo Falconi, Alessandro Zerbi, Stefano Crippa, Gianpaolo Balzano, Letizia Boninsegna, Vanessa Capitanio, Claudio Bassi, Valerio Di Carlo, Paolo Pederzoli

Research output: Contribution to journalArticle

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Abstract

Background. Parenchyma-preserving resections (PPRs), including enucleation and middle pancreatectomy (MP), are accepted procedures for insulinomas, but their role in the treatment of nonfunctioning pancreatic endocrine tumors (NF-PETs) is debated. The aim of this study was to evaluate perioperative and long-term outcomes after PPRs for NF-PETs. Methods. All patients who underwent PPRs for NF-PETs between 1990 and 2005 were included. Patients with multiple endocrine neoplasia type 1 were excluded. Results. Overall, 50 patients (23 men, 27 women, median age 59 years) underwent 26 enucleations and 24 MP. A total of 58% of NF-PETs were incidentally discovered. Median size of the tumors was 13.5 mm with no preoperative suspicion of malignancy in all patients. Overall morbidity and pancreatic fistula rates were 58 and 50%, respectively. Reoperation rate was 4%, with no mortality. Postoperative complications were higher in the MP group. At pathology, there were 34 (68%) benign lesions, 13 (26%) neoplasms of uncertain behavior, and 3 (6%) welldifferentiated carcinomas. Forty-one patients (82%) had tumors ≤2 cm in size. Only eight patients (16%) had at least one lymph node removed. After a median follow-up of 58 months, no patient died of disease. Overall, four patients (8%) experienced tumor recurrence after a mean of 68 months. The incidence of exocrine/endocrine insufficiency was 8%. Conclusions. PPRs are generally safe and effective procedures for treating small NF-PETs. However, better selection criteria must be identified, and lymph node sampling should be performed routinely to avoid understaging. Long-term follow-up evaluation (>5 years) is of paramount importance given the possible risk of late recurrence.

Original languageEnglish
Pages (from-to)1621-1627
Number of pages7
JournalAnnals of Surgical Oncology
Volume17
Issue number6
DOIs
Publication statusPublished - Jun 2010

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Neoplasms
Pancreatectomy
Lymph Nodes
Pancreatic Fistula
Multiple Endocrine Neoplasia Type 1
Recurrence
Insulinoma
Reoperation
Patient Selection
Pathology
Morbidity
Carcinoma
Mortality
Incidence
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Oncology

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Parenchyma-Preserving resections for small nonfunctioning pancreatic endocrine tumors. / Falconi, Massimo; Zerbi, Alessandro; Crippa, Stefano; Balzano, Gianpaolo; Boninsegna, Letizia; Capitanio, Vanessa; Bassi, Claudio; Di Carlo, Valerio; Pederzoli, Paolo.

In: Annals of Surgical Oncology, Vol. 17, No. 6, 06.2010, p. 1621-1627.

Research output: Contribution to journalArticle

Falconi, Massimo ; Zerbi, Alessandro ; Crippa, Stefano ; Balzano, Gianpaolo ; Boninsegna, Letizia ; Capitanio, Vanessa ; Bassi, Claudio ; Di Carlo, Valerio ; Pederzoli, Paolo. / Parenchyma-Preserving resections for small nonfunctioning pancreatic endocrine tumors. In: Annals of Surgical Oncology. 2010 ; Vol. 17, No. 6. pp. 1621-1627.
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abstract = "Background. Parenchyma-preserving resections (PPRs), including enucleation and middle pancreatectomy (MP), are accepted procedures for insulinomas, but their role in the treatment of nonfunctioning pancreatic endocrine tumors (NF-PETs) is debated. The aim of this study was to evaluate perioperative and long-term outcomes after PPRs for NF-PETs. Methods. All patients who underwent PPRs for NF-PETs between 1990 and 2005 were included. Patients with multiple endocrine neoplasia type 1 were excluded. Results. Overall, 50 patients (23 men, 27 women, median age 59 years) underwent 26 enucleations and 24 MP. A total of 58{\%} of NF-PETs were incidentally discovered. Median size of the tumors was 13.5 mm with no preoperative suspicion of malignancy in all patients. Overall morbidity and pancreatic fistula rates were 58 and 50{\%}, respectively. Reoperation rate was 4{\%}, with no mortality. Postoperative complications were higher in the MP group. At pathology, there were 34 (68{\%}) benign lesions, 13 (26{\%}) neoplasms of uncertain behavior, and 3 (6{\%}) welldifferentiated carcinomas. Forty-one patients (82{\%}) had tumors ≤2 cm in size. Only eight patients (16{\%}) had at least one lymph node removed. After a median follow-up of 58 months, no patient died of disease. Overall, four patients (8{\%}) experienced tumor recurrence after a mean of 68 months. The incidence of exocrine/endocrine insufficiency was 8{\%}. Conclusions. PPRs are generally safe and effective procedures for treating small NF-PETs. However, better selection criteria must be identified, and lymph node sampling should be performed routinely to avoid understaging. Long-term follow-up evaluation (>5 years) is of paramount importance given the possible risk of late recurrence.",
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T1 - Parenchyma-Preserving resections for small nonfunctioning pancreatic endocrine tumors

AU - Falconi, Massimo

AU - Zerbi, Alessandro

AU - Crippa, Stefano

AU - Balzano, Gianpaolo

AU - Boninsegna, Letizia

AU - Capitanio, Vanessa

AU - Bassi, Claudio

AU - Di Carlo, Valerio

AU - Pederzoli, Paolo

PY - 2010/6

Y1 - 2010/6

N2 - Background. Parenchyma-preserving resections (PPRs), including enucleation and middle pancreatectomy (MP), are accepted procedures for insulinomas, but their role in the treatment of nonfunctioning pancreatic endocrine tumors (NF-PETs) is debated. The aim of this study was to evaluate perioperative and long-term outcomes after PPRs for NF-PETs. Methods. All patients who underwent PPRs for NF-PETs between 1990 and 2005 were included. Patients with multiple endocrine neoplasia type 1 were excluded. Results. Overall, 50 patients (23 men, 27 women, median age 59 years) underwent 26 enucleations and 24 MP. A total of 58% of NF-PETs were incidentally discovered. Median size of the tumors was 13.5 mm with no preoperative suspicion of malignancy in all patients. Overall morbidity and pancreatic fistula rates were 58 and 50%, respectively. Reoperation rate was 4%, with no mortality. Postoperative complications were higher in the MP group. At pathology, there were 34 (68%) benign lesions, 13 (26%) neoplasms of uncertain behavior, and 3 (6%) welldifferentiated carcinomas. Forty-one patients (82%) had tumors ≤2 cm in size. Only eight patients (16%) had at least one lymph node removed. After a median follow-up of 58 months, no patient died of disease. Overall, four patients (8%) experienced tumor recurrence after a mean of 68 months. The incidence of exocrine/endocrine insufficiency was 8%. Conclusions. PPRs are generally safe and effective procedures for treating small NF-PETs. However, better selection criteria must be identified, and lymph node sampling should be performed routinely to avoid understaging. Long-term follow-up evaluation (>5 years) is of paramount importance given the possible risk of late recurrence.

AB - Background. Parenchyma-preserving resections (PPRs), including enucleation and middle pancreatectomy (MP), are accepted procedures for insulinomas, but their role in the treatment of nonfunctioning pancreatic endocrine tumors (NF-PETs) is debated. The aim of this study was to evaluate perioperative and long-term outcomes after PPRs for NF-PETs. Methods. All patients who underwent PPRs for NF-PETs between 1990 and 2005 were included. Patients with multiple endocrine neoplasia type 1 were excluded. Results. Overall, 50 patients (23 men, 27 women, median age 59 years) underwent 26 enucleations and 24 MP. A total of 58% of NF-PETs were incidentally discovered. Median size of the tumors was 13.5 mm with no preoperative suspicion of malignancy in all patients. Overall morbidity and pancreatic fistula rates were 58 and 50%, respectively. Reoperation rate was 4%, with no mortality. Postoperative complications were higher in the MP group. At pathology, there were 34 (68%) benign lesions, 13 (26%) neoplasms of uncertain behavior, and 3 (6%) welldifferentiated carcinomas. Forty-one patients (82%) had tumors ≤2 cm in size. Only eight patients (16%) had at least one lymph node removed. After a median follow-up of 58 months, no patient died of disease. Overall, four patients (8%) experienced tumor recurrence after a mean of 68 months. The incidence of exocrine/endocrine insufficiency was 8%. Conclusions. PPRs are generally safe and effective procedures for treating small NF-PETs. However, better selection criteria must be identified, and lymph node sampling should be performed routinely to avoid understaging. Long-term follow-up evaluation (>5 years) is of paramount importance given the possible risk of late recurrence.

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