Nicolas Santucci1,2,3, Sébastien Gaujoux4, Christine Binquet5,6, Cynthia Reichling7, Jean-Christophe Lifante8, Bruno Carnaille9, François Pattou9, Eric Mirallié10, Olivier Facy11, Muriel Mathonnet12, Pierre Goudet11,5. 1. Department of Digestive and Endocrine Surgery, Dijon University Hospital, University of Burgundy, Dijon, France. nicolas.santucci@chu-dijon.fr. 2. INSERM, U1231, EPICAD Team UMR "Lipids, Nutrition, Cancer", Dijon, France. nicolas.santucci@chu-dijon.fr. 3. Service de Chirurgie Digestive, Cancérologique et Endocrinienne, CHU « François Mitterrand », 14, rue Paul Gaffarel, 21079, Dijon Cedex, France. nicolas.santucci@chu-dijon.fr. 4. Department of Pancreatic and Endocrine Surgery, Cochin University Hospital, APHP, Paris, France. 5. INSERM, U1231, EPICAD Team UMR "Lipids, Nutrition, Cancer", Dijon, France. 6. INSERM, CIC1432, Clinical Epidemiology Unit, University of Burgundy-Franche-Comté, Dijon, France. 7. Department of Hepatogastroenterology and Digestive Oncology, Dijon University Hospital, University of Burgundy, Dijon Cedex, France. 8. Department of General, Digestive and Endocrine Surgery, University Hospital of Lyon Sud and EA 7425 HESPER, Health Services and Performance Research, University Claude-Bernard Lyon 1, Lyon, France. 9. Department of General and Endocrine Surgery, Lille University Hospital, Univ. Lille, INSERM U1190, Lille, France. 10. Department of General and Endocrine Surgery, University Hospital of Nantes, Nantes, France. 11. Department of Digestive and Endocrine Surgery, Dijon University Hospital, University of Burgundy, Dijon, France. 12. Department of General, Digestive and Endocrine Surgery, Dupuytren University Hospital, Limoges, France.
Abstract
AIM: To assess postoperative complications and control of hormone secretions following pancreatoduodenectomy (PD) performed on multiple endocrine neoplasia type 1 (MEN1) patients with duodenopancreatic neuroendocrine tumors (DP-NETs). BACKGROUND: The use of PD to treat MEN1 remains controversial, and evaluating the right place of PD in MEN1 disease makes sense. METHODS: Thirty-one MEN1 patients from the Groupe d'étude des Tumeurs Endocrines MEN1 cohort who underwent PD for DP-NETs between 1971 and 2013 were included. Early and late postoperative complications, secretory control and overall survival were analyzed. RESULTS: Indication for surgery was: Zollinger-Ellison syndrome (n = 18; 58%), nonfunctioning tumor (n = 9; 29%), insulinoma (n = 2; 7%), VIPoma (n = 1; 3%) and glucagonoma (n = 1; 3%). Mean follow-up was 141 months (range 0-433). Pancreatic fistulas occurred in 5 patients (16.1%), distant metastases in 6 (mean onset of 43 months; range 13-110 months), postoperative diabetes mellitus in 7 (22%), and pancreatic exocrine insufficiency in 6 (19%). Five-year overall survival was 93.3% [CI 75.8-98.3] and ten-year overall survival was 89.1% [CI 69.6-96.4]. After a mean follow-up of 151 months (range 0-433), the biochemical cure rate for MEN-1 related gastrinomas was 61%. CONCLUSION: In MEN1 patients, pancreatoduodenectomy can be used to control hormone secretions (gastrin, glucagon, VIP) and to remove large NETs. PD was found to control gastrin secretions in about 60% of cases.
AIM: To assess postoperative complications and control of hormone secretions following pancreatoduodenectomy (PD) performed on multiple endocrine neoplasia type 1 (MEN1) patients with duodenopancreatic neuroendocrine tumors (DP-NETs). BACKGROUND: The use of PD to treat MEN1 remains controversial, and evaluating the right place of PD in MEN1 disease makes sense. METHODS: Thirty-one MEN1patients from the Groupe d'étude des Tumeurs Endocrines MEN1 cohort who underwent PD for DP-NETs between 1971 and 2013 were included. Early and late postoperative complications, secretory control and overall survival were analyzed. RESULTS: Indication for surgery was: Zollinger-Ellison syndrome (n = 18; 58%), nonfunctioning tumor (n = 9; 29%), insulinoma (n = 2; 7%), VIPoma (n = 1; 3%) and glucagonoma (n = 1; 3%). Mean follow-up was 141 months (range 0-433). Pancreatic fistulas occurred in 5 patients (16.1%), distant metastases in 6 (mean onset of 43 months; range 13-110 months), postoperative diabetes mellitus in 7 (22%), and pancreatic exocrine insufficiency in 6 (19%). Five-year overall survival was 93.3% [CI 75.8-98.3] and ten-year overall survival was 89.1% [CI 69.6-96.4]. After a mean follow-up of 151 months (range 0-433), the biochemical cure rate for MEN-1 related gastrinomas was 61%. CONCLUSION: In MEN1patients, pancreatoduodenectomy can be used to control hormone secretions (gastrin, glucagon, VIP) and to remove large NETs. PD was found to control gastrin secretions in about 60% of cases.
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