Sporadic nonfunctioning pancreatic neuroendocrine tumors: prognostic significance of incidental diagnosis.
BACKGROUND
Sporadic nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs) are increasingly diagnosed as incidentalomas, and their resection is usually recommended. The prognostic significance of this diagnosis feature is poorly studied, and management of these tumors remains controversial. Clinical, pathologic characteristics and outcome of resected incidentally diagnosed NF-PNET (Inc) were compared with resected symptomatic NF-PNET (Symp) to better assess their biologic behavior and tailor their management.


METHODS
From 1994 to 2010, 108 patients underwent resection for sporadic nonmetastatic NF-PNET. Diagnosis was considered as incidental in patients with no abdominal symptoms or symptoms unlikely to be related to tumor mass. Patients with Inc were compared with patients with Symp, regarding demographics, postoperative course, pathology, and disease-free survival (DFS).


RESULTS
Of the 108 patients, 65 (61%) had incidentally diagnosed tumors. Pancreas-sparing pancreatectomies (enucleation/central pancreatectomy) were performed more frequently in Inc (62% vs 30%, P = .001). Inc tumors were more frequently <20 mm (65% vs 42%, P = .019), staged T1 (62% vs 33%, P = .0001), node negative (85% vs 60%; P = .005), and grade 1 (66% vs 33%, P = .0001). One postoperative death occurred in the Inc group, and postoperative morbidity was similar between the two groups (60% vs 65%, P = .59). DFS was substantially better in the Inc group (5-year DFS = 92% vs 82%, P = .0016).


CONCLUSIONS
Incidentally diagnosed NF-PNETs are associated with less aggressive features compared with symptomatic lesions but cannot always be considered to be benign. Operative resection remains recommended for most. Incidentally diagnosed NF-PNET may be good candidates for pancreas-sparing pancreatectomies.
Department of Hepato-Pancreato-Biliary Surgery - Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, hôpital Beaujon, Clichy, France.
David Jérémie
DJ
Birnbaum
Department of Hepato-Pancreato-Biliary Surgery - Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, hôpital Beaujon, Clichy, France; Université Paris Diderot, Paris, France; Centre de Recherche Biomédicale Bichat Beaujon (CRB3)/INSERM U773, Institut National de la Santé et de la Recherche Médicale, Paris, France.
Sébastien
S
Gaujoux
Department of Hepato-Pancreato-Biliary Surgery - Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, hôpital Beaujon, Clichy, France.
Rim
R
Cherif
Department of Hepato-Pancreato-Biliary Surgery - Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, hôpital Beaujon, Clichy, France.
Safi
S
Dokmak
Department of Hepato-Pancreato-Biliary Surgery - Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, hôpital Beaujon, Clichy, France; Université Paris Diderot, Paris, France.
David
D
Fuks
Université Paris Diderot, Paris, France; Centre de Recherche Biomédicale Bichat Beaujon (CRB3)/INSERM U773, Institut National de la Santé et de la Recherche Médicale, Paris, France; Département of Pathology, AP-HP, hôpital Beaujon, Clichy, France.
Anne
A
Couvelard
Department of Radiology, AP-HP, hôpital Beaujon, Clichy, France.
Marie-Pierre
MP
Vullierme
Université Paris Diderot, Paris, France; Département of Pathology, AP-HP, hôpital Beaujon, Clichy, France; Department of Radiology, AP-HP, hôpital Beaujon, Clichy, France.
Maxime
M
Ronot
Université Paris Diderot, Paris, France; Centre de Recherche Biomédicale Bichat Beaujon (CRB3)/INSERM U773, Institut National de la Santé et de la Recherche Médicale, Paris, France; Department of Gastroenterology, Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, hôpital Beaujon, Clichy, France.
Philippe
P
Ruszniewski
Department of Hepato-Pancreato-Biliary Surgery - Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, hôpital Beaujon, Clichy, France; Université Paris Diderot, Paris, France.
Jacques
J
Belghiti
Department of Hepato-Pancreato-Biliary Surgery - Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, hôpital Beaujon, Clichy, France; Université Paris Diderot, Paris, France. Electronic address: alain.sauvanet@bjn.aphp.fr.
Alain
A
Sauvanet
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D010179:Pancreas / Q000473:pathology; D010180:Pancreatectomy / Q000706:statistics & numerical data; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D059035:Perioperative Period / Q000706:statistics & numerical data; D011379:Prognosis; D012189:Retrospective Studies