title: Surgical resection provides an overall survival benefit for patients with small pancreatic neuroendocrine tumors.
abstract: BACKGROUND
  The optimal management of small (≤2 cm) pancreatic neuroendocrine tumors (PNETs) remains controversial. We evaluated these tumors in the National Cancer Data Base (NCDB) to determine if resection provides a survival advantage over observation.
  
  
  METHODS
  The NCDB was queried to identify patients with nonmetastatic PNETs ≤2 cm treated between 1998 and 2006. Kaplan-Meier survival estimates, stratified by grade and treatment type, evaluated the difference in 5-year overall survival (OS) between patients who underwent resection and observation. Multivariable Cox regression was used to determine the importance of resection in OS.
  
  
  RESULTS
  Three hundred eighty patients met inclusion criteria. Eighty-one percent underwent resection; 19% were observed. Five-year OS was 82.2% for patients who underwent surgery and 34.3% for those who were observed (p < 0.0001). When controlling for age, comorbidities, income, facility type, tumor size and location, grade, margin status, nodal status, surgical management, and nonsurgical therapy in the Cox model, observation [hazard ratio (HR) 2.80], poorly differentiated histology (HR 3.79), lymph node positivity (HR 2.01), and nonsurgical therapies (HR 2.23) were independently associated with an increase in risk of mortality (p < 0.01).
  
  
  CONCLUSIONS
  Patients with localized PNETs ≤2 cm had an overall survival advantage with resection compared to observation, independent of age, comorbidities, tumor grade, and treatment with nonsurgical therapies.
authors.affiliation: Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Sharpe
authors.forename: Haejin
authors.initials: H
authors.lastname: In
authors.forename: David J
authors.initials: DJ
authors.lastname: Winchester
authors.forename: Mark S
authors.initials: MS
authors.lastname: Talamonti
authors.forename: Marshall S
authors.initials: MS
authors.lastname: Baker
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018358:Neuroendocrine Tumors / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D016016:Proportional Hazards Models; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology