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Erschienen in: Journal of Gastrointestinal Surgery 6/2020

13.06.2019 | Original Article

Resection Versus Observation of Small Asymptomatic Nonfunctioning Pancreatic Neuroendocrine Tumors

verfasst von: Alex Barenboim, Guy Lahat, Ido Nachmany, Richard Nakache, Yaakov Goykhman, Ravit Geva, Ester Osher, Erez Scapa, Ido Wolf, Lior Orbach, Eli Brazowski, Ofer Isakov, Joseph M. Klausner, Nir Lubezky

Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 6/2020

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Abstract

Background

Management of asymptomatic, nonfunctioning small pancreatic neuroendocrine tumors (PNETs) is controversial because of their overall good prognosis, and the morbidity and mortality associated with pancreatic surgery. Our aim was to compare the outcomes of resection with expectant management of patients with small asymptomatic PNETs.

Methods

Retrospective review of patients with nonfunctioning asymptomatic PNETs < 2 cm that underwent resection or expectant management at the Tel-Aviv Medical Center between 2001 and 2018.

Results

Forty-four patients with small asymptomatic, biopsy-proven low-grade PNETs with a KI67 proliferative index < 3% were observed for a mean of 52.48 months. Gallium67DOTATOC-PET scan was completed in 32 patients and demonstrated uptake in the pancreatic tumor in 25 (78%). No patient developed systemic metastases. Two patients underwent resection due to tumor growth, and true tumor enlargement was evidenced in final pathology in one of them. Fifty-five patients underwent immediate resection. Significant complications (Clavien–Dindo grade ≥ 3) developed in 10 patients (18%), mostly due to pancreatic leak, and led to one mortality (1.8%). Pathological evaluation revealed lymphovascular invasion in 1 patient, lymph node metastases in none, and a Ki67 index ≥ 3% in 5. No case of tumor recurrence was diagnosed after mean follow-up of 52.8 months.

Conclusions

No patients with asymptomatic low-grade small PNETs treated by expectant management were diagnosed with regional or systemic metastases after a 52.8-month follow-up. Local tumor progression rate was 2.1%. Surgery has excellent long-term outcomes, but it harbors significant morbidity and mortality. Observation can be considered for selected patients with asymptomatic, small, low grade PNETs.
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Metadaten
Titel
Resection Versus Observation of Small Asymptomatic Nonfunctioning Pancreatic Neuroendocrine Tumors
verfasst von
Alex Barenboim
Guy Lahat
Ido Nachmany
Richard Nakache
Yaakov Goykhman
Ravit Geva
Ester Osher
Erez Scapa
Ido Wolf
Lior Orbach
Eli Brazowski
Ofer Isakov
Joseph M. Klausner
Nir Lubezky
Publikationsdatum
13.06.2019
Verlag
Springer US
Erschienen in
Journal of Gastrointestinal Surgery / Ausgabe 6/2020
Print ISSN: 1091-255X
Elektronische ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-019-04285-y

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