title: Aggressive multi-visceral pancreatic resections for locally advanced neuroendocrine tumours. Is it worth it?
abstract: BACKGROUND
  Traditional surgical principles state that pancreatic resection should not be contemplated when malignancies arise in the pancreas and involve other organs. While this is logic for ductal adenocarcinoma and other tumours with aggressive biological behavior; for even large neuroendocrine tumours, aggressive multivisceral resection may achieve useful palliation and excellent survival.
  
  
  METHODS
  Case records were retrospectively analyzed.
  
  
  METHODS
  Twelve consecutive patients (7 males, 5 females; median age 57 years, range: 37-79 years) underwent multi-visceral en bloc resections for neuroendocrine tumour arising in the pancreas between 1994 and 2008.
  
  
  RESULTS
  Three patients underwent pancreaticoduodenectomy; 9 patients had left sided pancreatic resections for neuroendocrine tumour of median diameter 9.5 cm (5-25 cm). They had a median of 3 (range: 1-4) additional organs resected. There were no post-operative deaths or late mortality with median follow up of 24 months. Five patients experienced a complication (major in 3 patients). Median disease free survival was not attained and 3 patients experienced recurrent disease mostly in the liver and may be candidates for further resection.
  
  
  CONCLUSIONS
  Aggressive multi-visceral resection for locally advanced neuroendocrine tumour involving the pancreas is technically feasible and in selected patients can be achieved with low mortality and acceptable morbidity, offering good disease free and overall survival. However this complex surgery should be only performed in specialist centers.
authors.affiliation: University Surgical Unit, Southampton General Hospital, Southampton, United Kingdom. abuhlal@yahoo.com
authors.forename: Mohammed
authors.initials: M
authors.lastname: Abu Hilal
authors.forename: Mark J W
authors.initials: MJ
authors.lastname: McPhail
authors.forename: Bashar A
authors.initials: BA
authors.lastname: Zeidan
authors.forename: Ceri E
authors.initials: CE
authors.lastname: Jones
authors.forename: Colin D
authors.initials: CD
authors.lastname: Johnson
authors.forename: Neil W
authors.initials: NW
authors.lastname: Pearce
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D018358:Neuroendocrine Tumors / Q000401:mortality* / Q000601:surgery*; D010166:Palliative Care / Q000706:statistics & numerical data; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies