Parenchyma-sparing Resection in a Non-functioning Neuroendocrine Tumor of the Pancreatic Neck

Abstract

Purpose: The aim is to present a case of pancreatic neuroendocrine tumor treated surgically by parenchymal sparing resection, central pancreatectomy. Method: 53-year-old woman with distended abdomen and intense epigastric pain of 3 days evolution and one year of abdominal discomfort. CT: pancreatic neck tumor. CEA, CA19.9 and negative hormones. Ultrasound-guided FNA: suspected G1 neuroendocrine tumor (Ki67 1% and synaptophysin +). Octreoscan negative for metastasis. Surgical treatment: central pancreatectomy, closure of the proximal pancreatic remnant and pancreatic-gastric anastomosis of the caudal remnant. AP: neuroendocrine tumor of the pancreatic neck G2 (T3N0M0), Ki67 15%, synaptophysin + and CgA +. Results and conclusions: Parenchyma-sparing resections (enucleation and central pancreatectomy) always aim to remove the tumor while preserving the maximum pancreatic tissue. Enucleation is indicated in non-functioning tumors, TNM stages l-ll of ENETS, <2cm, and with a safety margin between the tumor and the main pancreatic duct of 2-3mm. Some authors advocate parenchymal-sparing resections in tumors between 2-4cm, without evident lymph node disease. (In our case, a 3.5x2.5x2cm tumor in the pancreatic neck, with a distance <2-3mm to the pancreatic duct and no lymph node involvement). Lymphadenectomy should be performed based on the degree of tumor differentiation obtained by preoperative FNA, being indicated for G2 tumors, a group that includes tumors with a very wide range of Ki67 with uncertain significance. These resections are associated with a lower rate of de novo diabetes and better exocrine pancreatic function. However, the rate of postoperative fistulas increase, with more postoperative morbidity and risk of reoperations.