Kim-Fuchs, Corina; Rudigier, Meret; Malinka, Thomas; Candinas, Daniel; Gloor, Beat; Angst, Eliane (2016). Pancreatic Neuroendocrine Tumors: How Much Surgery is Safe? Journal of gastroenterology, pancreatology & liver disorders, 3(1), pp. 1-7. Symbiosis 10.15226/2374-815X/3/1/00148
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Background: Neuroendocrine tumors of the pancreas (pNET)
are rare. Often the patients are asymptomatic for a long time and
present late with metastasized disease. Although there are guidelines
for the treatment of these tumors, there is no clear consensus whether
the resection of liver metastases may be combined with the primary
tumor.
Method: We retrospectively analyzed the patients operated at our
institution between 1/2003 and 12/2012. The patients were analyzed
for demographic and clinical data, surgical treatment, tumor size and
stage, histology, complications, survival and tumor recurrence over
time.
Results: We analyzed 53 patients, 23 females, 30 males. Patients
with a one-step surgical approach to pancreas and liver had similar
morbidity and mortality compared to patients with disease confined
to the pancreas. The primary tumors were smaller in tumors confined
to the pancreas. Angioinvasion as well as positive lymph nodes
were strongly correlated with synchronous or metachronous liver
metastases. Progression free survival was shorter in patients with
primary metastasized disease.
Conclusion: The treatment of pNET is challenging. The surgical
approach should be tailored to the patient’s general condition.
Patients benefit from extended and combined resections even in
metastasized or locally advanced situations. Combined pancreatic and
hepatic surgery may be performed safely.
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