Abstract
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.
Highlights
Pancreatic neuroendocrine tumors (PNETs) are rare tumors with indolent behavior, representing 1 to 2% of all pancreatic cancers [1]
A controversy has arisen regarding the management of small NFPNETs, at it has been proposed that small tumors may be Gastroenterology Research and Practice observed in some cases [6]
The patient data collected included sex, age, weight, body mass index (BMI), Karnofsky performance status (KPS), American Society of Anesthesiologists (ASA) physical status, comorbidities, type of surgical resection, postoperative complications according to the Clavien-Dindo classification [9], postoperative pancreatic fistula, length of stay, followup, patient survival, and disease-free survival
Summary
Pancreatic neuroendocrine tumors (PNETs) are rare tumors with indolent behavior, representing 1 to 2% of all pancreatic cancers [1]. Many of these asymptomatic tumors are diagnosed in elderly patients with comorbidities In this context, surgical resection is still the gold standard of treatment for NF-PNETs, which is considered the only curative option in most cases and has a positive impact on survival. The present study is aimed at analyzing the outcomes of surgical resection of small (≤3 cm) NF-PNETs. The incidence of small nonfunctioning neuroendocrine pancreatic tumors (NF-PNETs) has been increasing systematically in the last few decades. 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. Conservative treatment should be indicated very cautiously for only cases with absolute contraindications for surgery
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