Small pancreatic and periampullary neuroendocrine tumors: resect or enucleate?
OBJECTIVE
The aim of this study was to compare the outcomes of enucleation versus resection in patients with small pancreatic, ampullary, and duodenal neuroendocrine tumors (NETs).


METHODS
Multi-institutional retrospective review identified all patients with pancreatic and peri-pancreatic NETs who underwent surgery from January 1990 to October 2008. Patients with tumors < or =3 cm and without nodal or metastatic disease were included.


RESULTS
Of the 271 patients identified, 122 (45%) met the inclusion criteria and had either an enucleation (n = 37) and/or a resection (n = 87). Enucleated tumors were more likely to be in the pancreatic head (P = 0.003) or functioning (P < 0.0001) and, when applicable, less likely to result in splenectomy (P = 0.0003). The rate of pancreatic fistula formation was higher after enucleation (P < 0.01), but the fistula severity tended to be worse following resection (P = 0.07). The enucleation and resection patients had similar operative times, blood loss, overall morbidity, mortality, hospital stay, and 5-year survival. However, for pancreatic head tumors, enucleation resulted in decreased blood loss, operative time, and length of stay compared to pancreaticoduodenectomy (P < 0.05).


CONCLUSIONS
These data suggest that most outcomes of enucleation and resection for small pancreatic and peri-pancreatic NETs are comparable. However, enucleation has better outcomes than pancreaticoduodenectomy for head lesions and the advantage of preserving splenic function for tail lesions.
Pitt
Susan C
SC
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202-5124, USA.
Pitt
Henry A
HA
Baker
Marshall S
MS
Christians
Kathleen
K
Touzios
John G
JG
Kiely
James M
JM
Weber
Sharon M
SM
Wilson
Stuart D
SD
Howard
Thomas J
TJ
Talamonti
Mark S
MS
Rikkers
Layton F
LF
D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D001707:Biopsy, Needle; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004379:Duodenal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000401:mortality; D009367:Neoplasm Staging; D018358:Neuroendocrine Tumors / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D010180:Pancreatectomy / Q000379:methods*; D016577:Pancreaticoduodenectomy / Q000379:methods; D011336:Probability; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D016717:Sphincterotomy, Endoscopic / Q000379:methods; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome