title: Pancreatic neuroendocrine tumours.
abstract: BACKGROUND
  Pancreatic neuroendocrine tumours (PNT) are infrequent epithelial neoplasms associated with a better outcome than pancreatic adenocarcinoma.
  
  
  METHODS
  We analysed our 22 years of experience in managing PNT. Forty-nine patients (27 women and 22 men) with a mean age of 49 years were studied. There were 28 insulinomas, eight glucagonomas, three gastrinomas, one VIPoma and one carcinoid. Eight patients presented with nonfunctional tumours. Enucleation was performed in 20 patients, distal pancreatectomy in 16, middle pancreatic resection in four, cephalic pancreatoduodenectomy in two and total pancreatoduodenectomy in one. In six patients, the tumour was not resected.
  
  
  RESULTS
  Postoperative complication rate was 22%: six pancreatic fistulas, three intra-abdominal collections, one remnant pancreatitis and one pancreatic pseudocyst. There was no mortality. 39 cases showed benign histologic features and ten malignant ones. Symptomatic palliation was achieved in 94% of the cases. Five patients presented recurrences: three liver metastases and two pancreatic recurrences. Actuarial mean survival was 163 months and was longer in insulinomas, in those tumours completely resected and in tumours with benign histological features.
  
  
  CONCLUSIONS
  Conservative surgery of the pancreas is preferred, but aggressive surgery is indicated when the primary tumour can be controlled. Despite of minimising pancreatic resection, there is a high complication rate, mainly pancreatic fistulas, though they can often be conservatively managed. Insulinomas are the PNT with better outcome; those completely resected also associate a better prognosis.
authors.affiliation: Servicio de Cirugía General, Hospital Universitario Ramón y Cajal, Madrid, Spain. jruiztovar@gmail.com
authors.forename: J
authors.initials: J
authors.lastname: Ruiz-Tovar
authors.forename: P
authors.initials: P
authors.lastname: Priego
authors.forename: E
authors.initials: E
authors.lastname: Martínez-Molina
authors.forename: V
authors.initials: V
authors.lastname: Morales
authors.forename: A
authors.initials: A
authors.lastname: Sanjuanbenito
authors.forename: E
authors.initials: E
authors.lastname: Lobo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D015408:Gastrinoma / Q000473:pathology / Q000601:surgery; D005935:Glucagonoma / Q000473:pathology / Q000601:surgery; D006801:Humans; D007340:Insulinoma / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018358:Neuroendocrine Tumors / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D010185:Pancreatic Fistula / Q000473:pathology / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D003969:Vipoma / Q000473:pathology / Q000601:surgery