title: Parenchyma-sparing surgery for pancreatic endocrine tumors.
abstract: Enucleation (EN) and middle pancreatectomy (MP) have been proposed as a treatment for G1 and G2 pancreatic neuroendocrine tumors (PNET). The aim of this study is to analyze the outcomes of parenchyma-sparing surgery (PSS) for PNET in an Italian high-volume center. All patients with a histological diagnosis of PNET who underwent surgical resection in our center between January 2010 and January 2016 were included in the study. Demographic, perioperative, and discharge data were collected in a prospective database. Follow-up was considered until March 31, 2016. 99 patients were included. PSS was performed in 22 cases (22.2 %), 18 EN (82 %), and 4 MP (18 %). 89.8 % patients were staged with CT scan, 69.6 % with endoscopic ultrasonography, 48.4 % with MRI, and 47.4 % with 68Ga-PET. Pre-operative histological diagnosis was obtained in 68.6 %. Most of PSS tumors were G1 (n = 15; 68 %) and there were no G3. Nodal sampling was performed in every PSS. Only two patients showed nodal metastatic disease. The median post-operative length of stay was 7 days after PSS. Eleven (50 %) of these patients developed a complication; two (18.2 %) were major complications. Pancreatic fistula developed in ten patients (45.5 %); two (20 %) were type B. There were no type C fistula and no re-operations after PSS. Readmission rate was 9 %. All patients submitted to PSS are alive and free of recurrence. PSS is a safe technique for G1 and G2 PNETs, but it has to be conducted in experienced centers and an extensive nodal sampling and a long follow-up are required for the best oncologic outcome.
authors.affiliation: Pancreatic Surgery Unit-Hospital Health Direction, Humanitas Research Hospital, Rozzano, MI, Italy. fara.uccelli@humanitas.it.
authors.forename: Fara
authors.initials: F
authors.lastname: Uccelli
authors.affiliation: Pancreatic Surgery Unit-Hospital Health Direction, Humanitas Research Hospital, Rozzano, MI, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Gavazzi
authors.affiliation: Pancreatic Surgery Unit-Hospital Health Direction, Humanitas Research Hospital, Rozzano, MI, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Capretti
authors.affiliation: Pancreatic Surgery Unit-Hospital Health Direction, Humanitas Research Hospital, Rozzano, MI, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Virdis
authors.affiliation: Chancellor of Humanitas University, Chief of Department of Surgery, Humanitas Research Hospital, Rozzano, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Montorsi
authors.affiliation: Pancreatic Surgery Unit-Hospital Health Direction, Humanitas Research Hospital, Rozzano, MI, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Zerbi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D018278:Carcinoma, Neuroendocrine / Q000175:diagnosis / Q000601:surgery*; D042241:Early Diagnosis; D019160:Endosonography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D000072356:Parenchymal Tissue / Q000000981:diagnostic imaging / Q000601:surgery*; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: NET; Neuroendocrine tumor; Pancreas; Parenchyma-sparing surgery; Surgical treatment