BACKGROUND: Parenchyma-sparing pancreatectomy (PSP), including enucleation and central pancreatectomy, has been investigated as an alternative to standard resection for pancreatic endocrine neoplasm, but the benefit/risk of these procedures remains little known. METHODS: From 1998 to 2010, among 197 patients operated for well-differentiated pancreatic neuroendocrine tumors, 67 underwent PSP (45 enucleations and 22 central pancreatectomies) and 66 standard resections (35 pancreaticoduodenectomies and 31 distal pancreatectomies) for a tumor below 4 cm, without synchronous distant metastasis. Groups were compared regarding postoperative morbidity, mortality, long-term pancreatic function, and survival calculated using the Kaplan-Meier method. RESULTS: Tumors operated by PSP had a median size of 15 mm, were mainly incidentally diagnosed (n = 46, 69 %), and nonfunctioning (n = 55, 82 %). Overall morbidity rate was higher after PSP than standard resection (SR) (76 vs 58 %, p = 0.0028), including more frequent pancreatic fistulas (69 vs 42 %, p = 0.003). Postoperative diabetes was less frequent following PSP than pancreaticoduodenectomy (5 vs 21 %; p = 0.022) but equivalent to the one observed after distal pancreatectomy (4 %, p = 1). Exocrine insufficiency was significantly less frequent after PSP than SR (3 vs 32 %; p < 0.0001). The overall and recurrence-free 5-year survival after PSP for nonfunctioning tumors was 96 and 98 %, respectively. CONCLUSION: In selected patients, with small and low-grade tumors, PSP are associated with excellent overall and recurrence-free survivals. These procedures are associated with an increased postoperative morbidity but an excellent postoperative pancreatic function. Therefore, they should be considered as a valid therapeutic option in selected well-differentiated pancreatic neuroendocrine tumors.
BACKGROUND: Parenchyma-sparing pancreatectomy (PSP), including enucleation and central pancreatectomy, has been investigated as an alternative to standard resection for pancreatic endocrine neoplasm, but the benefit/risk of these procedures remains little known. METHODS: From 1998 to 2010, among 197 patients operated for well-differentiated pancreatic neuroendocrine tumors, 67 underwent PSP (45 enucleations and 22 central pancreatectomies) and 66 standard resections (35 pancreaticoduodenectomies and 31 distal pancreatectomies) for a tumor below 4 cm, without synchronous distant metastasis. Groups were compared regarding postoperative morbidity, mortality, long-term pancreatic function, and survival calculated using the Kaplan-Meier method. RESULTS:Tumors operated by PSP had a median size of 15 mm, were mainly incidentally diagnosed (n = 46, 69 %), and nonfunctioning (n = 55, 82 %). Overall morbidity rate was higher after PSP than standard resection (SR) (76 vs 58 %, p = 0.0028), including more frequent pancreatic fistulas (69 vs 42 %, p = 0.003). Postoperative diabetes was less frequent following PSP than pancreaticoduodenectomy (5 vs 21 %; p = 0.022) but equivalent to the one observed after distal pancreatectomy (4 %, p = 1). Exocrine insufficiency was significantly less frequent after PSP than SR (3 vs 32 %; p < 0.0001). The overall and recurrence-free 5-year survival after PSP for nonfunctioning tumors was 96 and 98 %, respectively. CONCLUSION: In selected patients, with small and low-grade tumors, PSP are associated with excellent overall and recurrence-free survivals. These procedures are associated with an increased postoperative morbidity but an excellent postoperative pancreatic function. Therefore, they should be considered as a valid therapeutic option in selected well-differentiated pancreatic neuroendocrine tumors.
Authors: Alex B Haynes; Vikram Deshpande; Thun Ingkakul; Parsia A Vagefi; Jackie Szymonifka; Sarah P Thayer; Cristina R Ferrone; Jennifer A Wargo; Andrew L Warshaw; Carlos Fernández-del Castillo Journal: Arch Surg Date: 2011-05
Authors: John D Allendorf; Beth A Schrope; Margaret H Lauerman; William B Inabnet; John A Chabot Journal: World J Surg Date: 2007-01 Impact factor: 3.352
Authors: Steven N Hochwald; Sui Zee; Kevin C Conlon; Roberto Colleoni; Otway Louie; Murray F Brennan; David S Klimstra Journal: J Clin Oncol Date: 2002-06-01 Impact factor: 44.544
Authors: Michael W Müller; Helmut Friess; Jörg Kleeff; Ulf Hinz; Moritz N Wente; Daniel Paramythiotis; Pascal O Berberat; Güralp O Ceyhan; Markus W Büchler Journal: Ann Surg Date: 2006-12 Impact factor: 12.969
Authors: Guellue Cataldegirmen; Claus G Schneider; Dean Bogoevski; Alexandra Koenig; Jussuf T Kaifi; Maximilian Bockhorn; Lena S Deutsch; Yogesh Vashist; Jakob R Izbicki; Emre F Yekebas Journal: Surgery Date: 2009-12-11 Impact factor: 3.982
Authors: G Rindi; G Klöppel; H Alhman; M Caplin; A Couvelard; W W de Herder; B Erikssson; A Falchetti; M Falconi; P Komminoth; M Körner; J M Lopes; A-M McNicol; O Nilsson; A Perren; A Scarpa; J-Y Scoazec; B Wiedenmann Journal: Virchows Arch Date: 2006-09-12 Impact factor: 4.064
Authors: Jiro Kusakabe; Blaire Anderson; Jingxia Liu; Gregory A Williams; William C Chapman; Majella M B Doyle; Adeel S Khan; Dominic E Sanford; Chet W Hammill; Steven M Strasberg; William G Hawkins; Ryan C Fields Journal: J Gastrointest Surg Date: 2019-01-22 Impact factor: 3.452
Authors: Jasper Jan Atema; Anneke P J Jilesen; Olivier R C Busch; Thomas M van Gulik; Dirk J Gouma; Els J M Nieveen van Dijkum Journal: HPB (Oxford) Date: 2014-07-18 Impact factor: 3.647
Authors: Tommaso Giuliani; Giovanni Marchegiani; Mark D Girgis; Stefano Francesco Crinò; Venkataraman R Muthusamy; Laura Bernardoni; Antonio Pea; Marco Ramera; Salvatore Paiella; Luca Landoni; Armando Gabbrielli; Roberto Salvia; Timothy R Donahue; Claudio Bassi Journal: Surg Endosc Date: 2020-03-16 Impact factor: 4.584
Authors: Paul A Toste; Brian E Kadera; Sergei F Tatishchev; David W Dawson; Barbara M Clerkin; Raman Muthusamy; Rabindra Watson; James S Tomlinson; Oscar J Hines; Howard A Reber; Timothy R Donahue Journal: J Gastrointest Surg Date: 2013-10-08 Impact factor: 3.452