title: Small pancreatic and periampullary neuroendocrine tumors: resect or enucleate?
abstract: 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.
authors: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202-5124, USA.
authors: Susan C
authors: SC
authors: Pitt
authors: Henry A
authors: HA
authors: Pitt
authors: Marshall S
authors: MS
authors: Baker
authors: Kathleen
authors: K
authors: Christians
authors: John G
authors: JG
authors: Touzios
authors: James M
authors: JM
authors: Kiely
authors: Sharon M
authors: SM
authors: Weber
authors: Stuart D
authors: SD
authors: Wilson
authors: Thomas J
authors: TJ
authors: Howard
authors: Mark S
authors: MS
authors: Talamonti
authors: Layton F
authors: LF
authors: Rikkers
mesh_terms: 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