title: Parenchyma-preserving resections for small nonfunctioning pancreatic endocrine tumors.
abstract: BACKGROUND
  Parenchyma-preserving resections (PPRs), including enucleation and middle pancreatectomy (MP), are accepted procedures for insulinomas, but their role in the treatment of nonfunctioning pancreatic endocrine tumors (NF-PETs) is debated. The aim of this study was to evaluate perioperative and long-term outcomes after PPRs for NF-PETs.
  
  
  METHODS
  All patients who underwent PPRs for NF-PETs between 1990 and 2005 were included. Patients with multiple endocrine neoplasia type 1 were excluded.
  
  
  RESULTS
  Overall, 50 patients (23 men, 27 women, median age 59 years) underwent 26 enucleations and 24 MP. A total of 58% of NF-PETs were incidentally discovered. Median size of the tumors was 13.5 mm with no preoperative suspicion of malignancy in all patients. Overall morbidity and pancreatic fistula rates were 58 and 50%, respectively. Reoperation rate was 4%, with no mortality. Postoperative complications were higher in the MP group. At pathology, there were 34 (68%) benign lesions, 13 (26%) neoplasms of uncertain behavior, and 3 (6%) well-differentiated carcinomas. Forty-one patients (82%) had tumors < or =2 cm in size. Only eight patients (16%) had at least one lymph node removed. After a median follow-up of 58 months, no patient died of disease. Overall, four patients (8%) experienced tumor recurrence after a mean of 68 months. The incidence of exocrine/endocrine insufficiency was 8%.
  
  
  CONCLUSIONS
  PPRs are generally safe and effective procedures for treating small NF-PETs. However, better selection criteria must be identified, and lymph node sampling should be performed routinely to avoid understaging. Long-term follow-up evaluation (>5 years) is of paramount importance given the possible risk of late recurrence.
authors.affiliation: Chirurgia Generale B (Pancreas Unit), Department of Surgery, University of Verona, Policlinico GB Rossi, Verona, Italy. massimo.falconi@univr.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Falconi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zerbi
authors.forename: Stefano
authors.initials: S
authors.lastname: Crippa
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Balzano
authors.forename: Letizia
authors.initials: L
authors.lastname: Boninsegna
authors.forename: Vanessa
authors.initials: V
authors.lastname: Capitanio
authors.forename: Claudio
authors.initials: C
authors.lastname: Bassi
authors.forename: Valerio
authors.initials: V
authors.lastname: Di Carlo
authors.forename: Paolo
authors.initials: P
authors.lastname: Pederzoli
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018579:Patient Selection; D011446:Prospective Studies; D012086:Reoperation; D016896:Treatment Outcome