title: Therapeutic Strategies for Advanced Pancreatic Neuroendocrine Tumors with Segmental Portal Hypertension.
abstract: BACKGROUND
  Pancreatic neuroendocrine tumors (PNET) locally advanced may lead to significant local symptoms especially segmental portal hypertension (SPH) with risk of bleeding. The aim of our study was to evaluate the role of SPH on the PNET management in an expert center.
  
  
  METHODS
  Forty-two patients treated for locally advanced PNET with SPH between January 1984 and December 2012 were retrospectively analyzed.
  
  
  RESULTS
  The median age was 55 years (25-75). The median tumor size was 7.5 cm (3-20). Thirty four (80.9%) patients were metastatic mainly in the liver (n=33, 79%) with a frequent (n=16, 38.1%) involvement>20%. The surgery was impossible because of SPH in 7 (16.6%) cases. Pancreatic resection was performed in 28 (66.7%) cases by distal pancreatectomy. Neoadjuvant chemotherapy (n=24, 57%) had no impact on SPH with no modification of collateral circulation. Among operated on patients, complete macroscopic resection was obtained in 19 (67.8%) patients. The mortality and severe morbidity rate was respectively 3.6 and 18%. Five year overall survival (OS) was similar in operated and no operated patients. (61%; p=0.64). The 5-year OS was 77.9 or 55.4% in patients who underwent a complete or incomplete macroscopic resection of primary and metastases, respectively.
  
  
  CONCLUSIONS
  PNET resection associated with SPH is feasible with a low morbimortality. SPH was not improved by chemotherapy. Prolonged survival was observed after complete macroscopic resection.
authors: Department of Surgical Oncology, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France, fredericdumont3108@yahoo.fr.
authors: F
authors: F
authors: Dumont
authors: Y
authors: Y
authors: Goudard
authors: C
authors: C
authors: Caramella
authors: D
authors: D
authors: Goéré
authors: E
authors: E
authors: Baudin
authors: D
authors: D
authors: Elias
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018358:Neuroendocrine Tumors / Q000150:complications* / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies