title: Extended surgery for advanced pancreatic endocrine tumours.
abstract: BACKGROUND
  Pancreatic endocrine tumours are often diagnosed at an advanced stage with hepatic metastasis. This study investigated whether extended resections for advanced malignant pancreatic endocrine tumours influenced disease-free and disease-specific survival.
  
  
  METHODS
  Patients who had curative resection of pancreatic endocrine tumours were analysed retrospectively for disease-free and disease-specific survival, with a focus on the role of extended surgical resection.
  
  
  RESULTS
  Forty-one patients were included in the analysis, 13 of whom underwent extended surgical resection in addition to pancreatic resection. This included partial liver resection in nine patients, portal vein resection in three, partial gastric resection in five and liver transplantation in three patients. There were no deaths in hospital or within 30 days. Median follow-up was 40 (range 2-239) months. Thirty-five, 24 and 13 patients survived more than 1, 3 and 5 years respectively. Patients who underwent extended resection had similar disease-specific survival to those who had pancreatic resection alone (hazard ratio (HR) 1·50, 95 per cent confidence interval (c.i.) 0·35 to 6·35; P = 0·581) but with a higher frequency of complications (odds ratio (OR) 4·28, 95 per cent c.i. 1·04 to 17·62; P = 0·044). Among patients with liver metastases, the mortality rate was higher in those in whom liver resection was not possible than in patients who had liver resection (HR 9·24, 1·00 to 85·18; P = 0·049). Patients who had liver resection had similar disease-specific survival to those without liver metastases (HR 0·84, 0·09 to 7·57; P = 0·877).
  
  
  CONCLUSIONS
  Extended surgical resection for locally advanced and metastatic pancreatic endocrine tumours is feasible with encouraging disease-specific survival.
authors.affiliation: Department of General, Visceral and Transplant Surgery, Hanover, Germany. kleine.moritz@mh-hannover.de
authors.forename: M
authors.initials: M
authors.lastname: Kleine
authors.forename: H
authors.initials: H
authors.lastname: Schrem
authors.forename: F W R
authors.initials: FW
authors.lastname: Vondran
authors.forename: T
authors.initials: T
authors.lastname: Krech
authors.forename: J
authors.initials: J
authors.lastname: Klempnauer
authors.forename: H
authors.initials: H
authors.lastname: Bektas
mesh_terms: D000328:Adult; D000368:Aged; D018273:Carcinoma, Islet Cell / Q000401:mortality / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016017:Odds Ratio; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis