title: Surgery in malignant pancreatic neuroendocrine tumors.
abstract: BACKGROUND
  Because of their rarity and indolent nature, optimal management of malignant pancreatic neuroendocrine tumors remains controversial. The purpose of this study is to review a series of patients with these tumors and investigate the role of surgery in the treatment.
  
  
  METHODS
  A retrospective study of 73 patients (ages 24-86 years; 36 women) undergoing treatment at a tertiary academic medical center was performed. Patient demographics, diagnostic tests, operations, pathologic findings, adjuvant treatments, and survival were reviewed.
  
  
  RESULTS
  Seventy-four percent of patients had advanced disease with hepatic metastases and 30% had functional tumors. Fifty-seven percent of the patients underwent pancreatic resections. Two 60-day mortalities occurred and the postoperative complication rate was 27%. Overall 5-year survival rate was 44%. There was no difference in survival between patients with functional and nonfunctional tumors. Patients undergoing resection, even in metastatic disease, had better survival than patients who had no resection (60% vs. 30%, P = 0.025). Recurrence occurred in 20% of patients who underwent a curative resection.
  
  
  CONCLUSIONS
  Patients with malignant pancreatic neuroendocrine tumors commonly present with advanced disease. Although, curative resection is not frequent, survival benefit may be obtainable with aggressive surgical management even in the face of metastatic disease.
authors.affiliation: Department of Surgery, Division of General Surgery, The Mount Sinai School of Medicine, New York, New York 10029-6574, USA. scott.nguyen@mountsinai.org
authors.forename: Scott Q
authors.initials: SQ
authors.lastname: Nguyen
authors.forename: Luz P
authors.initials: LP
authors.lastname: Angel
authors.forename: Celia M
authors.initials: CM
authors.lastname: Divino
authors.forename: Stefanie
authors.initials: S
authors.lastname: Schluender
authors.forename: Richard R P
authors.initials: RR
authors.lastname: Warner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018358:Neuroendocrine Tumors / Q000401:mortality* / Q000556:secondary / Q000628:therapy*; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000628:therapy*; D011183:Postoperative Complications; D018714:Radiotherapy, Adjuvant; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate