Endocrine Abstracts (2006) 11 P525

Investigation and surgical management of pancreatic neuroendocrine tumours

FM Coyle1, WM Drake1, SL Chew1, P Jenkins1, RR Hutchins2, AB Grossman1, JP Monson1 & S Bhattacharya2

1Department of Endocrinology, London, United Kingdom; 2Department of Surgery, Barts and the London NHS Trust, London, United Kingdom.

Introduction: Diagnosis of pancreatic neuroendocrine tumours (NETs) is often a challenge and involves biochemical characterisation and anatomic localisation of the tumour. Wherever feasible, curative surgical excision is the treatment of choice.

Materials and Methods: Twenty four consecutive patients with pancreatic NETs were referred for consideration of surgery over a six-year period (1999–2005). Following use of multi imaging modalities to localise, all were operated on by the same surgical team.

Results: Twenty-four patients underwent surgical resection (11 women, 13 men; age 21–77 years, median 53). Sixteen tumours secreted known hormones (11 insulinomas, 1 somatostatinoma, 1 gastrinoma, 1 glucagonoma, and 2 multiple islet cell tumours) and 8 were non-functioning. Three tumours were part of the MEN 1 Syndrome. All 24 tumours were successfully localised prior to resection. Operations performed included 7 pylorus preserving pancreatoduodenectomies, 7 tumour enucleations, 7 distal pancreatectomies, 1 duodenum-preserving resection of pancreatic head, 1 excision of retropancreatic gastrinoma, and 1 liver segment resection were performed. There were no fatalities. Six patients (25%) had perioperative complications. These included wound infection (2), pancreatic leak managed conservatively with drainage and octreotide (2), and peri-pancreatic collection requiring percutaneous drainage (2). One late complication involved a duodenal stricture after a duodenum-preserving resection of the pancreatic head. Complete excision with symptomatic cure was documented in 20 patients. Of the remaining 4, two had MEN 1 with multiple islet cell tumours. One patient with neuroendocrine carcinoma (positive resection margins) received adjuvant chemotherapy. One patient had MIBG avid liver metastases and received targeted radiotherapy for these.

Conclusion: Accurate pre-operative localisation can be achieved in pancreatic NETs and facilitates pancreas sparing surgery. Surgical resection can be performed in high-volume centres with a very low mortality and acceptable morbidity, and carries a high likelihood of cure.

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