title: Surgical treatment of non-functioning pancreatic neuroendocrine tumours based on three clinical scenarios.
abstract: BACKGROUND
  The treatment of patients with non-functioning pancreatic neuroendocrine tumours (NFPNET) is resection in locally pancreatic disease, or with resectable liver metastases. There is controversy about unresectable liver disease.
  
  
  METHODS
  We analysed the perioperative data and survival outcome of 63 patients who underwent resection of NFPNET between 1993 and 2012. They were divided into 3 scenarios: A, pancreatic resection (44patients); B, pancreatic and liver resection in synchronous resectable liver metastases (12patients); and C, pancreatic resection in synchronous unresectable liver metastases (6patients). The prognostic factors for survival and recurrence were studied.
  
  
  RESULTS
  Distal pancreatectomy (51%) and pancreaticoduodenectomy (38%) were more frequently performed. Associated surgery was required in 44% of patients, including synchronous liver resections in 9patients. Two patients received a liver transplant during follow-up. According to the WHO classification they were distributed into G1: 10 (16%), G2: 45 (71%), and G3: 8 (13%). The median hospital stay was 11days. Postoperative morbidity and mortality were 49% and 1.6%, respectively. At the closure of the study, 43 (68%) patients were still alive, with a mean actuarial survival of 9.6years. The WHO classification and tumour recurrence were risk factors of mortality in the multivariate analysis. The median actuarial survival by scenarios was 131months (A), 102months (B), and 75months (C) without statistically significant differences.
  
  
  CONCLUSIONS
  Surgical resection is the treatment for NFPNET without distant disease. Resectable liver metastases in well-differentiated tumours must be resected. The resection of the pancreatic tumour with unresectable synchronous liver metastasis must be considered in well-differentiated NFPNET. The WHO classification grade and recurrence are risk factors of long-term mortality.
authors.affiliation: Servicio de Cirugía General y Digestivo, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, España. Electronic address: jbusquets@bellvitgehospital.cat.
authors.forename: Juli
authors.initials: J
authors.lastname: Busquets
authors.affiliation: Servicio de Cirugía General y Digestivo, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, España.
authors.forename: Elena
authors.initials: E
authors.lastname: Ramírez-Maldonado
authors.affiliation: Servicio de Anatomía Patológica, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, España.
authors.forename: Teresa
authors.initials: T
authors.lastname: Serrano
authors.affiliation: Servicio de Cirugía General y Digestivo, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, España.
authors.forename: Núria
authors.initials: N
authors.lastname: Peláez
authors.affiliation: Servicio de Cirugía General y Digestivo, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, España.
authors.forename: Luís
authors.initials: L
authors.lastname: Secanella
authors.affiliation: Servicio de Radiodiagnóstico, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, España.
authors.forename: Sandra
authors.initials: S
authors.lastname: Ruiz-Osuna
authors.affiliation: Servicio de Cirugía General y Digestivo, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, España.
authors.forename: Emilio
authors.initials: E
authors.lastname: Ramos
authors.affiliation: Servicio de Cirugía General y Digestivo, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, España.
authors.forename: Laura
authors.initials: L
authors.lastname: Lladó
authors.affiliation: Servicio de Cirugía General y Digestivo, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, España.
authors.forename: Juan
authors.initials: J
authors.lastname: Fabregat
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D015996:Survival Rate
keywords: Duodenopancreatectomía cefálica; Liver metastases; Liver resection; Metástasis hepáticas; Non-functioning pancreatic neuroendocrine tumour; Pancreatic resection; Pancreaticoduodenectomy; Resección hepática; Resección pancreática; Tumor neuroendocrino pancreático no funcionante