Prognosis of sporadic resected small (≤2 cm) nonfunctional pancreatic neuroendocrine tumors – a multi-institutional study

• Published in: HPB (Oxford, England) Vol. 20; no. 3; pp. 251 - 259
• Main Authors: Sallinen, Ville J., Le Large, Tessa Y.S., Tieftrunk, Elke, Galeev, Shamil, Kovalenko, Zahar, Haugvik, Sven-Petter, Antila, Anne, Franklin, Oskar, Martinez-Moneo, Emma, Robinson, Stuart M., Panzuto, Francesco, Regenet, Nicolas, Muffatti, Francesca, Partelli, Stefano, Wiese, Dominik, Ruszniewski, Philippe, Dousset, Bertrand, Edwin, Bjørn, Bartsch, Detlef K., Sauvanet, Alain, Falconi, Massimo, Ceyhan, Güralp O., Gaujoux, Sebastien
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-03-2018
• Subjects: Aged; Bile Ducts - pathology; Databases, Factual; Dilatation, Pathologic; Disease-Free Survival; Europe; Female; Humans; Male; Middle Aged; Neoplasm Grading; Neoplasm Recurrence, Local; Neuroendocrine Tumors - diagnostic imaging; Neuroendocrine Tumors - mortality; Neuroendocrine Tumors - pathology; Neuroendocrine Tumors - surgery; Pancreatectomy - adverse effects; Pancreatectomy - mortality; Pancreatic Ducts - pathology; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy - adverse effects; Pancreaticoduodenectomy - mortality; Retrospective Studies; Risk Factors; Time Factors; Tumor Burden; Europe
• ISSN: 1365-182X; 1477-2574; 1477-2574
• DOI: 10.1016/j.hpb.2017.08.034

Malignant potential of small (≤20 mm) nonfunctional pancreatic neuroendocrine tumors (sNF-PNET) is difficult to predict and management remain controversial. The aim of this study was to assess the prognosis of sporadic nonmetastatic sNF-PNETs.
Patients were identified from databases of 16 centers. Outcomes and risk factors for recurrence were identified by uni- and multivariate analyses.
sNF-PNET was resected in 210 patients, and 66% (n = 138) were asymptomatic. Median age was 60 years, median tumor size was 15 mm, parenchyma-sparing surgery was performed in 42%. Postoperative mortality was 0.5% (n = 1), severe morbidity rate was 14.3% (n = 30), and 14 of 132 patients (10.6%) with harvested lymph nodes had metastatic lymph nodes. Tumor size, presence of biliary or pancreatic duct dilatation, and WHO grade 2–3 were independently associated with recurrence. Patients with tumors sized ≤10 mm were disease free at last follow-up. The 1-, 3- and 5-year disease-free survival rates for patients with tumors sized 11–20 mm on preoperative imaging were 95.1%, 91.0%, and 87.3%, respectively.
In sNF-PNETs, the presence of biliary or pancreatic duct dilatation or WHO grade 2–3 advocate for surgical treatment. In the remaining patients, a wait-and-see policy might be considered.