Outcome after laparoscopic enucleation for non-functional neuroendocrine pancreatic tumours.
BACKGROUND
Non-functional endocrine pancreatic tumours (NPT) of more than 2 cm have an increased risk of malignancy. The aim of the present study was: (i) to define the guidelines for laparoscopic enucleation (LapEn) in patients with a non-functional NPT ≤3 cm in diameter; (ii) to evaluate pancreas-related complications; and (iii) to present the long-term outcome.


METHODS
Between April 1998 and September 2010, 30 consecutive patients underwent laparoscopic surgery for a non-functional NPT (median age 56.5 years, range 44-83). Only 13 patients with tumours ≤3 cm in size underwent LapEn. Local lymph node dissection to exclude lymph node involvement was performed in all patients.


RESULTS
The median tumour size, operative time and blood loss were 2.8 cm (range 2.8-3), 130 min (range 90-280) and 220 ml (range 120-300), respectively. A pancreatic fistula occurred in five patients: International Study Group of Pancreatic Fistula (ISGPF) A in two patients and ISGPF B in three patients. The median follow-up was 48 months (12-144). Three patients with well-differentiated carcinoma are free of disease 2, 3 and 4 years after LapEn and a regional lymphadenectomy. One patient, 5 years after a LapEn, presented with lymph node and liver metastases.


CONCLUSIONS
The present study confirms the technical feasibility and acceptable morbidity associated with LapEn. Intra-operative lymph node sampling and frozen-section examination should be performed at the time of LapEn; when a malignancy is confirmed, oncologically appropriate lymph node dissection should be performed.
Surgical Department, ICMDM, Hospital Clínic de Barcelona, Barcelona, Spain. lfcruz@clinic.ub.es
Laureano
L
Fernández-Cruz
Víctor
V
Molina
Rodrigo
R
Vallejos
Enrique
E
Jiménez Chavarria
Miguel-Angel
MA
López-Boado
Joana
J
Ferrer
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002454:Cell Differentiation; D005240:Feasibility Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008113:Liver Neoplasms / Q000556:secondary; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000556:secondary / Q000601:surgery*; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010185:Pancreatic Fistula / Q000209:etiology; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden