title: Multidisciplinary treatment strategy for advanced pancreatic neuroendocrine tumors- a single center experience.
abstract: OBJECTIVE
  Pancreatic neuroendocrine tumors (PNETs) are rare neoplasms. Little is known about the mode of recurrence and long term prognosis after resection. We aimed to evaluate the surgical indication, especially for the patients with concomitant multiple liver metastases or extreme local invasions.
  
  
  METHODS
  The overall survival (OS) and the disease free survival (DFS) were statistically analyzed for twenty one patients with PNETs who underwent surgical intervention in our institute. The patients were divided into 2 groups, G1 NET (grade 1 neuroendocrine tumor: n=11) and G2 NET (grade 2 neuroendocrine tumor: n=10), according to WHO 2010 classification. The radical operation was indicated if curative resection were expected to be achievable. Otherwise,alternative multi-disciplinary treatments were introduced especially for the hepatic metastasis or repeated recurrences.
  
  
  RESULTS
  Median follow-up period was 37 months (range 7-69). OS was 100% at 3 years and 86% at 5 years. DFS was 62% at 3 years and 39% at 5 years. Disease recurrence developed more frequently in G2 NET, compared to G1 NET. However, there was statistically no difference for the OS between these two groups.
  
  
  CONCLUSIONS
  Appropriate radical operation with multi-disciplinary treatments could contribute to the patients' survival in the treatment strategy of PNETs.
authors.affiliation: Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan. tsuchi-t@med.hokudai.ac.jp
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tsuchikawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirano
authors.forename: Eiichi
authors.initials: E
authors.lastname: Tanaka
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kato
authors.forename: Joe
authors.initials: J
authors.lastname: Matsumoto
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Sichinohe
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003299:Cooperative Behavior; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D033183:Interdisciplinary Communication; D007564:Japan; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D009937:Organizational Objectives; D010180:Pancreatectomy / Q000009:adverse effects / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D010348:Patient Care Team / Q000458:organization & administration; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult