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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.

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Massachusetts General Hospital, Wang 460, 15 Parkman Street, Boston, MA, USA.
Massachusetts General Hospital, Wang 460, 15 Parkman Street, Boston, MA, USA.



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.


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.


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.


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.


Nonfunctioning; Pancreatic neuroendocrine tumor; Resection; Size; Surgery

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