title: Is surgery beneficial for MEN1 patients with small (< or = 2 cm), nonfunctioning pancreaticoduodenal endocrine tumor? An analysis of 65 patients from the GTE.
abstract: BACKGROUND
  The management of small, nonfunctioning pancreaticoduodenal endocrine tumors (NFPET) in multiple endocrine neoplasia type 1 (MEN1) patients is still controversial. We therefore investigated the effect of surgery on survival and tumor progression in MEN1 patients with NFPET < or = 2 cm by analyzing data from the Groupe des Tumeurs Endocrines (GTE) registry.
  
  
  METHODS
  Among 579 MEN1 patients in the registry, 65 had NFPET < or = 2 cm. Fifteen (23%) underwent pancreatectomy, 9 at least segmental pancreatectomies and 6 biopsies or enucleations (the surgery group), and 50 (77%) were followed conservatively (the no surgery group). Age at MEN1 and NFPET diagnosis was similar in both groups, as was size of the primary tumor. Seven (10.8%) patients had metastases. Five metastases were synchronous, and 2 (one in each group) were metachronous. Tumor size was similar in patients with or without metastasis.
  
  
  RESULTS
  There was no perioperative mortality. The average follow-up time after NFPET diagnosis was 6.7 years in the surgery group and 3.3 years in the no surgery group. Three (4.6%) patients died during follow-up, 2 due to NFPET and 1 due to thymus tumor. The 2 patients who died of NFPET had undergone pancreatic surgery at the time of NFPET diagnosis. The 2 groups did not differ significantly with respect to tumor progression [5/15 (33%) vs 6/38 (16%), P = 0.16]. Overall life expectancy of patients with NFPET < or = 2 cm was not different than that of the 229 MEN1 patients in the registry without any pancreaticoduodenal tumor (P = 0.33).
  
  
  CONCLUSIONS
  This study suggests that surgery may not be beneficial for MEN1 patients with NFPET < or = 2 cm.
authors: Department of General and Endocrine Surgery, University Hospital, Lille, France. frederic.triponez@hcuge.ch
authors: Frederic
authors: F
authors: Triponez
authors: Pierre
authors: P
authors: Goudet
authors: David
authors: D
authors: Dosseh
authors: Patrick
authors: P
authors: Cougard
authors: Catherine
authors: C
authors: Bauters
authors: Arnaud
authors: A
authors: Murat
authors: Guillaume
authors: G
authors: Cadiot
authors: Patricia
authors: P
authors: Niccoli-Sire
authors: Alain
authors: A
authors: Calender
authors: Charles A G
authors: CA
authors: Proye