Insights of Outcome after Resection of Small Nonfunctioning Neuroendocrine Pancreatic Tumors

Background. The incidence of small nonfunctioning neuroendocrine pancreatic tumors (NF-PNETs) has been increasing systematically in the last few decades. Surgical resection was once considered the treatment of choice but has been questioned in the direction of a more conservative approach for selected patients. Our aim was to analyze the outcome of surgical resection of small (≤3cm) NF-PNETs. Methods. We retrospectively evaluated 14 patients with sporadic NF-PNETs who underwent pancreatic resection. Data were collected from patients’ medical records. Results. Of the 14 patients included, 35.71% were men, and the average age was 52.36 ± 20.36 years. Comorbidities were present in 92.86% of the cases. The incidence of postoperative complications was 42.86%, the 30-day mortality was zero, and the length of follow-up was 3.31 ± 3.0 years. The results of pathological evaluations revealed WHO grade I in 42.86% of cases, II in 21.43%, and neuroendocrine carcinoma in 35.71%. The median tumor size was 1.85cm (range, 0.5–3cm), and 2 cases had synchronous metastasis. The median TNM stage was IIa (range, I–IV). The disease-free and patient survival rates were 87.5% and 100% at 3 years and 43.75% and 75% at 10 years, respectively. The tumor pathological grade was significantly higher in head tumors than body-tail tumors, but there were no differences with respect to tumor size and TNM staging. Conclusion. A surgical approach to treat small sporadic NF-PNETs is safe with low mortality and high patient survival. Based on these data, small pancreatic head tumors can be more aggressive, suggesting that surgical resection is still the best option to treat small nonfunctioning PNETS. Thus, conservative treatment should be indicated very cautiously for only cases with absolute contraindications for surgery.

NEW POSSIBILITIES OF COMPLEX TREATMENT FOR METASTATIC AND LOCALLY ADVANCED NEUROENDOCRINE TUMORS OF THE PANCREAS

During the period 2006 to 2017 years 86 patients with neuroendocrine pancreatic tumors were observed and treated. 25 (29,1%) patients underwent only chemotherapy due to generalized tumor process or severe concomitant somatic status. 61 (70,9%) patients with neuroendocrine pancreatic tumors underwent surgical treatment. In 34 patients tumors were localized in the body and tail, in 27 - in the head of the pancreas. Women predominated among patients (n = 41), the average age of the patients was 51 ± 3.1 years. Synchronous metastatic liver metastases were detected in 33 (54,1%) of 61 patients, with the size of the primary tumor from 10 to 73 mm. In 47 (77%) neuroendocrine pancreatic tumors were regarded as non-functioning. Radical surgery was performed in 24 patients of 61 (39,3%) with tumor sizes from 11 to 128 mm (average 56 ± 21 mm), cytoreductive surgery was performed in 37 (60.7%) patients. Patients with locally advanced neuroendocrine pancreatic tumors (n = 13) and neuroendocrine pancreatic tumors with synchronous liver metastases (n = 33) undergone combined treatment (n = 46). Combined treatment was performed by means of intra-arterial selective oil chemoembolization and chemoinfusion, supplemented with one or several local methods effects: cytoreductive surgery and radiofrequency ablation (n = 8). 6 (12.2%) of patients with high, moderately and low-grade tumors died after the operation in period from 7 to 63 months from progression of disease. 43 (87.8%) patients survived in period from 4 to 112 months, 32 patients still alive without signs of disease progression. Because of recurrence in five patients (11.9%) repeated operations were performed. One patient (2.4%) underwent conformal radiation therapy. Life expectancy after surgery in patients with low-grade neuroendocrine cancer of the pancreas ranged from 3 to 16 months, and the median survival was 8.3 ± 1.2 months.