Aggressive multi-visceral pancreatic resections for locally advanced neuroendocrine tumours. Is it worth it?
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.
Abu Hilal
Mohammed
M
University Surgical Unit, Southampton General Hospital, Southampton, United Kingdom. abuhlal@yahoo.com
McPhail
Mark J W
MJ
Zeidan
Bashar A
BA
Jones
Ceri E
CE
Johnson
Colin D
CD
Pearce
Neil W
NW
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