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Abstract
Introduction Pancreatic neuroendocrine tumours (PNETS) often present late. At diagnosis 65% of patients have metastases, with median survival of 24 months.1 2 The conventional approach is conservative management. Recent evidence has suggested that aggressive treatment leads to better outcomes.3 We aim to show that in a cohort of patients with advanced PNETs aggressive resection prolongs survival.
Methods All patients with intra-abdominal neuro-endocrine tumours (NETs) were assessed by the Hepato-pancreatobiliary and NET MDTs from April 2005 to January 2012 were prospectively registered on a database. All patients with PNETs were identified. Demographic, treatment, peri-operative and survival data were analysed using SPSS. Peri-operative morbidity was graded using the Clavien system. Predicted survival was calculated using the Kaplan–Meier method.
Results 239 patients were assessed. 61 patients had PNETs (36 female: 25 males) Median age of 65. 55 patients underwent 71 resections. 52 had primary tumours resected and three patients had the primary tumour left in situ. Procedures included: 29 conventional pancreatic resections; 17 extended (including vascular or multi-visceral resections); nine had pancreatic and liver (four synchronous, five sequential) resections; 16 were liver resections alone. 27 patients had 48 additional medical and radiological interventions. Peri-operative mortality was 0%. Overall morbidity 42%. Median blood loss was 700 ml. Three operated patients died from progressive disease. Five non-surgical patients died. Overall survival for PNETs was 92% at median follow-up of 3 years. Predicted 5 year survival rate was 72% in operated patients.
Conclusion An aggressive multi-modal approach with resection of advanced PNETs leads to excellent long term survival with acceptable morbidity in patients.
Competing interests None declared.
References 1. Yao JC, et al. Everolimus for advanced pancreatic neuroendocrine tumours. N Engl J Med 2011;364:514–23.
2. Yao JC, et al. One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumours in 35,825 cases in the United States. J Clin Oncol 2008;26:3063–72.
3. Ong SL, et al. A fuller understanding of pancreatic neuroendocrine tumours combined with aggressive managemment improves outcome. Pancreatology 2009;9:583–600.