Elsevier

Surgery

Volume 132, Issue 6, December 2002, Pages 976-983
Surgery

American Association of Endocrine Surgeons
Concurrent resections of pancreatic islet cell cancers with synchronous hepatic metastases: Outcomes of an aggressive approach*

Presented at the 23rd Annual Meeting of the American Association of Endocrine Surgeons, Banff, Alberta, Canada, April 7-9, 2002.
https://doi.org/10.1067/msy.2002.128615Get rights and content

Abstract

Background. Pancreatic islet cell cancers are often characterized by the presence of endocrinopathies, an indolent clinical course, and a propensity for hepatic metastases. Hepatic metastases are associated with a negative impact on survival. The role of concurrent resections of pancreatic islet cell cancers and the hepatic metastases has not been defined. Methods. The records of all consecutive patients undergoing concurrent resections of pancreatic islet cell cancers and their hepatic metastases between 1980 and 1998 were reviewed. Outcomes regarding overall progression-free and symptom-free survival and perioperative morbidity and mortality were assessed. Results. All 23 patients underwent distal pancreatectomy and splenectomy. Six major (≥ 3 segments) and 17 minor (c3 segments) partial hepatectomies were performed. Complete gross resection of cancer (R0/R1) were performed in 9 patients and debulking resections (R2) (<10% residual tumor volume) in 14 patients. There were no perioperative deaths. Major complications occurred in 4 patients (18%). Overall, progression-free, and symptom-free survival was 71% (median: 76 months), 5% (median: 21 months), and 24% (median: 26 months), respectively, at 5 years. Conclusions. These data support aggressive concurrent resection of the pancreatic islet cell cancers and synchronic hepatic metastases when technically feasible. Because disease progression is frequent and the major cause of death, investigations of adjuvant and adjunctive therapies are warranted. (Surgery 2002;132:976-83.)

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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Reprint requests: David M. Nagorney, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905.

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