title: Pancreatic endocrine tumors with major vascular abutment, involvement, or encasement and indication for resection.
abstract: BACKGROUND
  Surgery for pancreatic endocrine tumors (PETs) with blood vessel involvement is controversial.
  
  
  OBJECTIVE
  Resection of PETs with major blood vessel involvement can be beneficial.
  
  
  METHODS
  The combined databases of the National Institutes of Health and Stanford University hospitals were queried.
  
  
  METHODS
  Operation, pathologic condition, complications, and disease-free and overall survival.
  
  
  RESULTS
  Of 273 patients with PETs, 46 (17%) had preoperative computed tomography evidence of major vascular involvement. The mean size for the primary PET was 5.0 cm. The involved major vessel was as follows: portal vein (n = 20), superior mesenteric vein or superior mesenteric artery (n = 16), inferior vena cava (n = 4), splenic vein (n = 4), and heart (n = 2). Forty-two of 46 patients had a PET removed: 12 (27%) primary only, 30 (68%) with lymph nodes, and 18 (41%) with liver metastases. PETs were removed by either enucleation (n = 7) or resection (n = 35). Resections included distal or subtotal pancreatectomy in 23, Whipple in 10, and total in 2. Eighteen patients had concomitant liver resection: 10 wedge resection and 8 anatomic resections. Nine patients had vascular reconstruction: each had reconstruction of the superior mesenteric vein and portal vein, and 1 had concomitant reconstruction of the superior mesenteric artery. There were no deaths, but 12 patients had complications. Eighteen patients (41%) were immediately disease free, and 5 recurred with follow-up, leaving 13 (30%) disease-free long term. The 10-year overall survival was 60%. Functional tumors were associated with a better overall survival (P < .001), and liver metastases decreased overall survival (P < .001).
  
  
  CONCLUSIONS
  These findings suggest that surgical resection of PETs with vascular abutment/invasion and nodal or distant metastases is indicated.
authors.affiliation: Department of Surgery, Stanford University Medical Center, Stanford, CA 94305-5641, USA. janorton@stanford.edu
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Norton
authors.forename: Edmund J
authors.initials: EJ
authors.lastname: Harris
authors.forename: Yijun
authors.initials: Y
authors.lastname: Chen
authors.forename: Brendan C
authors.initials: BC
authors.lastname: Visser
authors.forename: George A
authors.initials: GA
authors.lastname: Poultsides
authors.forename: Pamela C
authors.initials: PC
authors.lastname: Kunz
authors.forename: George A
authors.initials: GA
authors.lastname: Fisher
authors.forename: Robert T
authors.initials: RT
authors.lastname: Jensen
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D015408:Gastrinoma / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005935:Glucagonoma / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D018761:Multiple Endocrine Neoplasia Type 1 / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D009361:Neoplasm Invasiveness; D010190:Pancreatic Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D055815:Young Adult