Operative Versus Nonoperative Management of Nonfunctioning Pancreatic Neuroendocrine Tumors

• Published in: Journal of gastrointestinal surgery Vol. 20; no. 2; pp. 277 - 283
• Main Authors: Zhang, Irene Y., Zhao, Jing, Fernandez-del Castillo, Carlos, Braun, Yvonne, Razmdjou, Shadi, Warshaw, Andrew L., Lillemoe, Keith D., Ferrone, Cristina R.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-02-2016; Springer Nature B.V
• Subjects: 2015 SSAT Plenary Presentation; Adolescent; Adult; Aged; Aged, 80 and over; Asymptomatic; Female; Gastroenterology; Hormones; Humans; Male; Medicine; Medicine & Public Health; Metastasis; Middle Aged; Neuroendocrine tumors; Neuroendocrine Tumors - mortality; Neuroendocrine Tumors - pathology; Neuroendocrine Tumors - surgery; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Pathology; Patient Selection; Retrospective Studies; Surgery; Surgical outcomes; Survival Rate; Treatment Outcome; Young Adult; United States > US; Resection; Surgery; Size; Nonfunctioning; Pancreatic neuroendocrine tumor
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-015-3043-5

Introduction
Surgical resection is the only curative treatment for pancreatic neuroendocrine tumors (PNETs), but pancreatic operations carry a significant morbidity. We investigated whether the resection of small, asymptomatic nonfunctioning PNETs is beneficial. Clinicopathologic factors were retrospectively reviewed for all PNET cases from 1998 to 2014.
Methods
Kaplan-Meier survival and multivariable regression analyses were performed. A total of 249 patients had nonfunctioning PNETs with adequate follow-up, of whom 193 were resected and 56 were observed. Median age was 56 years, and 48 % of the patients were female.
Results
Overall, the resected patients had a significantly longer survival (OS) (
p
 = 0.001). However, for the patients with PNETs ≤2.5 cm in size and without metastasis at presentation, tumor size significantly modified the effect of resection on overall survival (
p
 < 0.05). The protective effect of resection increased as tumor size increased. An operation became a significant predictor of overall survival for tumors >1.5 cm (
p
 = 0.050 or less for larger tumors) but was not significant for tumors <1.5 cm (
p
 = 0.317 or more for smaller tumors), controlling for age-adjusted Charlson comorbidity index.
Conclusion
Resection of nonfunctioning PNETs over 1.5 cm is independently and significantly associated with a longer survival. However, the benefit of resection for tumors under 1.5 cm is unclear.