Aggressive multi-visceral pancreatic resections for locally advanced neuroendocrine tumours. Is it worth it?

Abu Hilal, Mohammed, McPhail, Mark J.W., Zeidan, Bashar A., Jones, Ceri E., Johnson, Colin D. and Pearce, Neil W. (2009) Aggressive multi-visceral pancreatic resections for locally advanced neuroendocrine tumours. Is it worth it? JOP: Journal of the Pancreas, 10 (3), 276-279.

Abstract

Context

Traditional surgical principles state that pancreatic resection should not be contemplated when malignancies arise in thepancreas and involve other organs. While this is logic for ductal adenocarcinoma and other tumours with aggressive biologicalbehavior; for even large neuroendocrine tumours, aggressive multivisceral resection may achieve useful palliation and excellent survival.

Design

Case records were retrospectively analyzed.

Patients and interventions

Twelve consecutive patients (7 males, 5 females; median age 57 years, range: 37-79 years) underwent multi-visceral en bloc resections for neuroendocrine tumour arising in the pancreas between 1994 and 2008.

Results

Three patients underwent pancreaticoduodenectomy; 9 patients had left sided pancreatic resections for neuroendocrine tumour of median diameter 9.5 cm ( 5-25 cm). They had a median of 3 (range: 1-4) additional organs resected. There were no post-operative deaths or late mortality with median follow up of 24 months. Five patients experienced a complication (major in 3 patients). Median disease free survival was not attained and 3 patients experienced recurrent disease mostly in the liver and may be candidates for further resection.

Conclusion

Aggressive multi-visceral resection for locally advanced neuroendocrine tumour involving the pancreas is technically feasible and in selected patients can be achieved with low
mortality and acceptable morbidity, offering good disease free and overall survival. However this complex surgery should be only performed in specialist centers.

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