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J Gastrointest Surg. 2016 Feb;20(2):277-83. doi: 10.1007/s11605-015-3043-5. Epub 2015 Dec 21.

Operative Versus Nonoperative Management of Nonfunctioning Pancreatic Neuroendocrine Tumors.

Author information

1
Massachusetts General Hospital, Wang 460, 15 Parkman Street, Boston, MA, USA.
2
Massachusetts General Hospital, Wang 460, 15 Parkman Street, Boston, MA, USA. cferrone@partners.org.

Abstract

INTRODUCTION:

Surgical resection is the only curative treatment for pancreatic neuroendocrine tumors (PNETs), but pancreatic operations carry a significant morbidity. We investigated whether the resection of small, asymptomatic nonfunctioning PNETs is beneficial. Clinicopathologic factors were retrospectively reviewed for all PNET cases from 1998 to 2014.

METHODS:

Kaplan-Meier survival and multivariable regression analyses were performed. A total of 249 patients had nonfunctioning PNETs with adequate follow-up, of whom 193 were resected and 56 were observed. Median age was 56 years, and 48 % of the patients were female.

RESULTS:

Overall, the resected patients had a significantly longer survival (OS) (p = 0.001). However, for the patients with PNETs ≤2.5 cm in size and without metastasis at presentation, tumor size significantly modified the effect of resection on overall survival (p < 0.05). The protective effect of resection increased as tumor size increased. An operation became a significant predictor of overall survival for tumors >1.5 cm (p = 0.050 or less for larger tumors) but was not significant for tumors <1.5 cm (p = 0.317 or more for smaller tumors), controlling for age-adjusted Charlson comorbidity index.

CONCLUSION:

Resection of nonfunctioning PNETs over 1.5 cm is independently and significantly associated with a longer survival. However, the benefit of resection for tumors under 1.5 cm is unclear.

KEYWORDS:

Nonfunctioning; Pancreatic neuroendocrine tumor; Resection; Size; Surgery

PMID:
26691146
DOI:
10.1007/s11605-015-3043-5
[Indexed for MEDLINE]

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