American Association of Endocrine SurgeonsConcurrent resections of pancreatic islet cell cancers with synchronous hepatic metastases: Outcomes of an aggressive approach*
Section snippets
Methods
The records of all consecutive patients undergoing concurrent resections of PIC and hepatic metastases at the Mayo Clinic in Rochester, Minn, between 1980 and 1998 were studied. This study period was chosen to provide a minimum following-up of 3 years, given the prognosis and indolent course of PIC from our past study.2 Patients with hepatic metastases who had resection of the PIC and biopsy of hepatic metastases or patients who had staged resections of the primary cancer and hepatic metastases
Results
Twenty-eight patients presented with PIC and hepatic metastases. Five patients underwent staged resections at the discretion of the primary surgeon. The remaining 23 patients are the subject of this report. Gender distribution was even with 12 men and 11 women. Mean (± SD) age was 53 ± 12 years.
The frequency of cancers by hormonal markers was: nonfunctioning, 7; glucagonoma, 6; insulinoma, 2; corticotropin-producing tumors, 2; polyfunctional tumors, 2; gastrinoma, 1; VIPoma, 1; carcinoid, 1;
Discussion
We believe that the treatment for hepatic metastases from neuroendocrine cancers is resection if the primary cancer has been resected or is grossly resectable and more than 90% (by volume) of the hepatic metastases are resectable.2 Whether this approach is preferable for patients with PIC presenting with overt hepatic metastases is undefined. Concurrent resection of both the primary cancer and hepatic metastases has been criticized because of the presumed perioperative risks associated with
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Cited by (114)
Pancreatic neuroendocrine neoplasms: The latest surgical and medical treatment strategies based on the current World Health Organization classification
2020, Critical Reviews in Oncology/HematologyRole of palliative resection of the primary tumour in advanced pancreatic and small intestinal neuroendocrine tumours: A systematic review and meta-analysis
2017, European Journal of Surgical OncologyCitation Excerpt :Surgery with curative intent is indicated for EP-NET with liver metastases, provided there is absence of extra-hepatic metastases, diffuse bilobar liver involvement, or compromised hepatic function.5 Resection of the intestinal or pancreatic primary, in conjunction with synchronous or delayed liver resection can achieve cure, particularly in low-grade tumours.6–9,9,10,10,11 However, the majority of EP-NETs present with unresectable stage IV disease, and the benefit of surgery to the primary lesion, particularly in asymptomatic non-secretory tumours, remains controversial.
Chapter 93 - Hepatic metastasis from neuroendocrine cancers
2017, Blumgart's Surgery of the Liver, Biliary Tract and Pancreas: Sixth EditionLong-term outcomes and prognostic factors in neuroendocrine carcinomas of the pancreas: Morphology matters
2016, Surgery (United States)
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Reprint requests: David M. Nagorney, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905.