title: Cytoreduction results in high perioperative mortality and decreased survival in patients undergoing pancreatectomy for neuroendocrine tumors of the pancreas.
abstract: We reviewed our experience with pancreatectomy for neuroendocrine tumors (NE) to determine outcomes after R0/R1 or R2 resection and compare them to patients in whom resection was not attempted. Data were reviewed for all patients presenting with NE tumors of the pancreas between 1990 and 2005. Kaplan-Meier survival curves were compared by log-rank analysis. Multivariate analysis was completed using Cox proportional hazards to identify risk factors for poor survival after resection. Of 120 patients, 65 (54%) had functional tumors. Resection was undertaken in 83: distal pancreatectomy in 41, pancreaticoduodenectomy in 27, enucleation in 14, and central pancreatectomy in 1. Survival was significantly longer after resection (91 months versus 24, P<0.001). R0/R1 resection was accomplished in 64 (77%) and resulted in lower perioperative mortality (2% versus 21%, P<0.01) and longer survival (112 months versus 24, P<0.001) compared to R2 resection. Survival after R2 resection was no better than after no resection. Factors predictive of decreased survival were moderate/poor differentiation, R2 resection, and high-risk features. Long-term survival is possible following complete resection for NE tumors of the pancreas. However, cytoreduction resulting in incomplete tumor removal carries significant perioperative mortality without long-term survival benefit and should be discouraged.
authors.affiliation: Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio 43210, USA. Mark.Bloomston@osumc.edu
authors.forename: Mark
authors.initials: M
authors.lastname: Bloomston
authors.forename: Peter
authors.initials: P
authors.lastname: Muscarella
authors.forename: Manisha H
authors.initials: MH
authors.lastname: Shah
authors.forename: Wendy L
authors.initials: WL
authors.lastname: Frankel
authors.forename: Osama
authors.initials: O
authors.lastname: Al-Saif
authors.forename: Edward W
authors.initials: EW
authors.lastname: Martin
authors.forename: E Christopher
authors.initials: EC
authors.lastname: Ellison
mesh_terms: D000328:Adult; D000368:Aged; D018273:Carcinoma, Islet Cell / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018358:Neuroendocrine Tumors / Q000401:mortality* / Q000601:surgery*; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D016016:Proportional Hazards Models; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome