Is surgery indicated for patients with symptomatic nonfunctioning pancreatic neuroendocrine tumor and unresectable hepatic metastases?
BACKGROUND
Patients with advanced pancreatic neuroendocrine tumor, even in the presence of unresectable hepatic metastases, have survival usually measured in years than in months. Theoretically, we would have reason to resect symptomatic primary pancreatic neuroendocrine tumors from these patients palliatively. However, the effect and feasibility of removing symptomatic primary pancreatic neuroendocrine tumor in patients with unresectable hepatic metastases has never been addressed.


METHODS
In 2000, we instituted a prospective study to resect symptomatic primary tumors and treat unresectable hepatic metastases by lanreotide and hepatic artery embolization in patients with definite tissue proof of pancreatic neuroendocrine tumor.


RESULTS
Thirteen patients were included in this study; seven patients underwent pancreaticoduodenectomy, and six underwent distal pancreatectomy and splenectomy. There were no operative deaths. Eight of thirteen patients had no radiologic evidence of disease progression. The other five patients had disease progression by their 6-month follow-up; they underwent hepatic artery chemoembolization or chemotherapy. One patient died of multiple lung and bone metastases 80 months after operation, and one patient died of continuous progression of liver metastases 18 months after operation. Telephone interviews of 11 patients who survived revealed that 10 reported improved quality of life after resection of symptomatic primary pancreatic neuroendocrine tumor and one patient reported no change.


CONCLUSIONS
We suggest that symptomatic primary pancreatic neuroendocrine tumors should be resected even when unresectable hepatic metastases are found at diagnosis because of the relatively low risk of pancreatic surgery, effective elimination of symptoms caused by primary tumors, and slow progression of hepatic metastases under lanreotide and hepatic artery embolization.
Hung
Ji-Shiang
JS
Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, ROC.
Chang
Ming-Chu
MC
Lee
Po-Huang
PH
Tien
Yu-Wen
YW
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004621:Embolization, Therapeutic; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000556:secondary* / Q000628:therapy*; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D010456:Peptides, Cyclic / Q000627:therapeutic use; D011446:Prospective Studies; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use; D013156:Splenectomy
D000970:Antineoplastic Agents; D010456:Peptides, Cyclic; C060347:lanreotide; D013004:Somatostatin