title: Aggressive surgery improves long-term survival in neuroendocrine pancreatic tumors: an institutional experience.
abstract: OBJECTIVE
  To evaluate surgical strategies for neuroendocrine pancreatic tumors (NEPT) in the light of the new WHO classification from 2004 and to draw conclusions for future surgical concepts.
  
  
  BACKGROUND
  : The extent of surgical resection in primary and recurrent NEPT is unclear.
  
  
  METHODS
  Between 1987 and 2004, 62 patients with sporadic NEPT were treated at our institution and sections from biopsy and resection specimen were histopathologically reclassified. Clinical presentation, surgery, metastases, and pattern of recurrence were related to survival.
  
  
  RESULTS
  Fifteen well-differentiated tumors (WDT, 24%), 39 low-grade carcinomas (LGC, 63%), and 8 high-grade carcinomas (HGC, 13%) were identified. Median observation time was 30.5 months; 48 of 62 patients (78%) were surgically resected, and in 45 patients R0/R1 status was achieved. Overall 2- and 5-year survival in the latter group was 80% and 64%, respectively. Retrospective WHO classification revealed that organ-preserving segmental resections had been performed in 10 LGC and 1 HGC. These patients showed equal outcome as radically resected counterparts (n = 19). Liver and other organ metastases were present in 19 of 62 patients (31%), and resection was accomplished in 7 of 19 patients, which conferred better overall survival (P = 0.026, log-rank test); 21 of 45 R0/R1-resected patients (47%) suffered from recurrence, and reoperation was accomplished in 9 patients, which resulted in better overall survival (P = 0.066).
  
  
  CONCLUSIONS
  Organ-preserving resections offer sufficient local control in LGC; therefore, radical resections do not seem to be justified. On the other hand, radical resection is indicated even in metastasized patients or in case of loco-regional recurrence. The silent and slow course of the disease facilitates long-term surgical control.
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Center of Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany. schurr@uke.uni-hamburg.de
authors.forename: Paulus G
authors.initials: PG
authors.lastname: Schurr
authors.forename: Tim
authors.initials: T
authors.lastname: Strate
authors.forename: Kim
authors.initials: K
authors.lastname: Rese
authors.forename: Jussuf T
authors.initials: JT
authors.lastname: Kaifi
authors.forename: Uta
authors.initials: U
authors.lastname: Reichelt
authors.forename: Susanne
authors.initials: S
authors.lastname: Petri
authors.forename: Helge
authors.initials: H
authors.lastname: Kleinhans
authors.forename: Emre F
authors.initials: EF
authors.lastname: Yekebas
authors.forename: Jakob R
authors.initials: JR
authors.lastname: Izbicki
mesh_terms: D001706:Biopsy; D018278:Carcinoma, Neuroendocrine / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome