Outcomes of resected nonfunctional pancreatic neuroendocrine tumors: Do size and symptoms matter?
Background Nonfunctional pancreatic neuroendocrine tumors (NF-PNETs) are rare tumors with highly variable outcome. Current guidelines recommend surveillance for small tumors (≤2 cm), but a scientific basis for such recommendation is scarce. Methods Patients who underwent surgery for NF-PNET during 2...
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| Veröffentlicht in: | Surgery 2015-12, Vol.158 (6), p.1556-1563 |
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| description | Background Nonfunctional pancreatic neuroendocrine tumors (NF-PNETs) are rare tumors with highly variable outcome. Current guidelines recommend surveillance for small tumors (≤2 cm), but a scientific basis for such recommendation is scarce. Methods Patients who underwent surgery for NF-PNET during 2001–2013 were identified from a prospectively maintained database and reviewed retrospectively. Results Fifty-eight patients that had undergone an operative procedure for NF-PNET were identified. Forty-one patients (71%) were symptomatic. Median size of the tumor was 2.5 cm (range 0.9–12.0 cm). WHO 2010 grade was predictive of both overall- and disease-free survival ( P |
| doi_str_mv | 10.1016/j.surg.2015.04.035 |
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Current guidelines recommend surveillance for small tumors (≤2 cm), but a scientific basis for such recommendation is scarce. Methods Patients who underwent surgery for NF-PNET during 2001–2013 were identified from a prospectively maintained database and reviewed retrospectively. Results Fifty-eight patients that had undergone an operative procedure for NF-PNET were identified. Forty-one patients (71%) were symptomatic. Median size of the tumor was 2.5 cm (range 0.9–12.0 cm). WHO 2010 grade was predictive of both overall- and disease-free survival ( P < .001), whereas size alone was not. Twenty-four patients had a small NF-PNET (≤2 cm), of whom 16 were symptomatic and 8 asymptomatic. Seven patients with small symptomatic NF-PNETs showed signs of malignant behavior: 4 had lymph node metastases, 1 had liver metastases before surgery, 3 developed liver metastases, and 3 died of the disease. All 7 patients had either bile duct or pancreatic duct obstruction or both on preoperative imaging. On the contrary, patients with small asymptomatic NF-PNETs did not develop distant metastases nor died of disease. Conclusion The 2010 grading system from the World Health Organization can be used to predict survival. Symptomatic small NF-PNETs that caused bile and/or pancreatic duct obstruction had poor outcome. In contrast, asymptomatic small NF-PNETs seem to have benign course, and are candidates for surveillance.</description><identifier>ISSN: 0039-6060</identifier><identifier>EISSN: 1532-7361</identifier><identifier>DOI: 10.1016/j.surg.2015.04.035</identifier><identifier>PMID: 26070847</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Cholestasis - diagnosis ; Disease Progression ; Female ; Humans ; Incidence ; Lymphatic Metastasis - diagnosis ; Male ; Middle Aged ; Neoplasm Grading ; Neuroendocrine Tumors - mortality ; Neuroendocrine Tumors - pathology ; Neuroendocrine Tumors - surgery ; Pancreatectomy - methods ; Pancreatic Neoplasms - mortality ; Pancreatic Neoplasms - pathology ; Pancreatic Neoplasms - surgery ; Predictive Value of Tests ; Prospective Studies ; Retrospective Studies ; Surgery ; Survival Rate ; Treatment Outcome ; Tumor Burden ; World Health Organization</subject><ispartof>Surgery, 2015-12, Vol.158 (6), p.1556-1563</ispartof><rights>Elsevier Inc.</rights><rights>2015 Elsevier Inc.</rights><rights>Copyright © 2015 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c591t-aae20b680bc27b4f0d1be8c503b7afbb92af8208478503d264d1a8db8efb59d13</citedby><cites>FETCH-LOGICAL-c591t-aae20b680bc27b4f0d1be8c503b7afbb92af8208478503d264d1a8db8efb59d13</cites><orcidid>0000-0001-5394-4169</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.surg.2015.04.035$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,778,782,3539,27911,27912,45982</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26070847$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sallinen, Ville, MD, PhD</creatorcontrib><creatorcontrib>Haglund, Caj, MD, PhD</creatorcontrib><creatorcontrib>Seppänen, Hanna, MD, PhD</creatorcontrib><title>Outcomes of resected nonfunctional pancreatic neuroendocrine tumors: Do size and symptoms matter?</title><title>Surgery</title><addtitle>Surgery</addtitle><description>Background Nonfunctional pancreatic neuroendocrine tumors (NF-PNETs) are rare tumors with highly variable outcome. Current guidelines recommend surveillance for small tumors (≤2 cm), but a scientific basis for such recommendation is scarce. Methods Patients who underwent surgery for NF-PNET during 2001–2013 were identified from a prospectively maintained database and reviewed retrospectively. Results Fifty-eight patients that had undergone an operative procedure for NF-PNET were identified. Forty-one patients (71%) were symptomatic. Median size of the tumor was 2.5 cm (range 0.9–12.0 cm). WHO 2010 grade was predictive of both overall- and disease-free survival ( P < .001), whereas size alone was not. Twenty-four patients had a small NF-PNET (≤2 cm), of whom 16 were symptomatic and 8 asymptomatic. Seven patients with small symptomatic NF-PNETs showed signs of malignant behavior: 4 had lymph node metastases, 1 had liver metastases before surgery, 3 developed liver metastases, and 3 died of the disease. All 7 patients had either bile duct or pancreatic duct obstruction or both on preoperative imaging. On the contrary, patients with small asymptomatic NF-PNETs did not develop distant metastases nor died of disease. Conclusion The 2010 grading system from the World Health Organization can be used to predict survival. Symptomatic small NF-PNETs that caused bile and/or pancreatic duct obstruction had poor outcome. In contrast, asymptomatic small NF-PNETs seem to have benign course, and are candidates for surveillance.</description><subject>Adult</subject><subject>Aged</subject><subject>Cholestasis - diagnosis</subject><subject>Disease Progression</subject><subject>Female</subject><subject>Humans</subject><subject>Incidence</subject><subject>Lymphatic Metastasis - diagnosis</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasm Grading</subject><subject>Neuroendocrine Tumors - mortality</subject><subject>Neuroendocrine Tumors - pathology</subject><subject>Neuroendocrine Tumors - surgery</subject><subject>Pancreatectomy - methods</subject><subject>Pancreatic Neoplasms - mortality</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Survival Rate</subject><subject>Treatment Outcome</subject><subject>Tumor Burden</subject><subject>World Health Organization</subject><issn>0039-6060</issn><issn>1532-7361</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUlvFDEQhS1ERIbAH-CAfOTSTdm9I0SEwpJIkXIAzpaXauSh2x68IA2_HrcmcOCQk0vWe09V3yPkBYOaAetf7-uYw_eaA-tqaGtoukdkx7qGV0PTs8dkB9BMVQ89nJOnMe4BYGrZ-ISc8x4GGNthR-RdTtqvGKmfacCIOqGhzrs5O52sd3KhB-l0QJmspg5z8OiM18E6pCmvPsQ39IOn0f5GKp2h8bgekl8jXWVKGC6fkbNZLhGf378X5Nunj1-vrqvbu883V-9vK91NLFVSIgfVj6A0H1Q7g2EKR91BowY5KzVxOY98W3osf4b3rWFyNGrEWXWTYc0FeXXKPQT_M2NMYrVR47JIhz5HwYaGDePAWVuk_CTVwccYcBaHYFcZjoKB2NCKvdjQig2tgFYUtMX08j4_qxXNP8tflkXw9iTAcuUvi0FEbdFpNDYUrMJ4-3D-u__serHOarn8wCPGvc-hlFHuEJELEF-2crduWVemvhuaP7YioYA</recordid><startdate>20151201</startdate><enddate>20151201</enddate><creator>Sallinen, Ville, MD, PhD</creator><creator>Haglund, Caj, MD, PhD</creator><creator>Seppänen, Hanna, MD, PhD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5394-4169</orcidid></search><sort><creationdate>20151201</creationdate><title>Outcomes of resected nonfunctional pancreatic neuroendocrine tumors: Do size and symptoms matter?</title><author>Sallinen, Ville, MD, PhD ; Haglund, Caj, MD, PhD ; Seppänen, Hanna, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c591t-aae20b680bc27b4f0d1be8c503b7afbb92af8208478503d264d1a8db8efb59d13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Cholestasis - diagnosis</topic><topic>Disease Progression</topic><topic>Female</topic><topic>Humans</topic><topic>Incidence</topic><topic>Lymphatic Metastasis - diagnosis</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoplasm Grading</topic><topic>Neuroendocrine Tumors - mortality</topic><topic>Neuroendocrine Tumors - pathology</topic><topic>Neuroendocrine Tumors - surgery</topic><topic>Pancreatectomy - methods</topic><topic>Pancreatic Neoplasms - mortality</topic><topic>Pancreatic Neoplasms - pathology</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Survival Rate</topic><topic>Treatment Outcome</topic><topic>Tumor Burden</topic><topic>World Health Organization</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sallinen, Ville, MD, PhD</creatorcontrib><creatorcontrib>Haglund, Caj, MD, PhD</creatorcontrib><creatorcontrib>Seppänen, Hanna, MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sallinen, Ville, MD, PhD</au><au>Haglund, Caj, MD, PhD</au><au>Seppänen, Hanna, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of resected nonfunctional pancreatic neuroendocrine tumors: Do size and symptoms matter?</atitle><jtitle>Surgery</jtitle><addtitle>Surgery</addtitle><date>2015-12-01</date><risdate>2015</risdate><volume>158</volume><issue>6</issue><spage>1556</spage><epage>1563</epage><pages>1556-1563</pages><issn>0039-6060</issn><eissn>1532-7361</eissn><abstract>Background Nonfunctional pancreatic neuroendocrine tumors (NF-PNETs) are rare tumors with highly variable outcome. Current guidelines recommend surveillance for small tumors (≤2 cm), but a scientific basis for such recommendation is scarce. Methods Patients who underwent surgery for NF-PNET during 2001–2013 were identified from a prospectively maintained database and reviewed retrospectively. Results Fifty-eight patients that had undergone an operative procedure for NF-PNET were identified. Forty-one patients (71%) were symptomatic. Median size of the tumor was 2.5 cm (range 0.9–12.0 cm). WHO 2010 grade was predictive of both overall- and disease-free survival ( P < .001), whereas size alone was not. Twenty-four patients had a small NF-PNET (≤2 cm), of whom 16 were symptomatic and 8 asymptomatic. Seven patients with small symptomatic NF-PNETs showed signs of malignant behavior: 4 had lymph node metastases, 1 had liver metastases before surgery, 3 developed liver metastases, and 3 died of the disease. All 7 patients had either bile duct or pancreatic duct obstruction or both on preoperative imaging. On the contrary, patients with small asymptomatic NF-PNETs did not develop distant metastases nor died of disease. Conclusion The 2010 grading system from the World Health Organization can be used to predict survival. Symptomatic small NF-PNETs that caused bile and/or pancreatic duct obstruction had poor outcome. In contrast, asymptomatic small NF-PNETs seem to have benign course, and are candidates for surveillance.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26070847</pmid><doi>10.1016/j.surg.2015.04.035</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-5394-4169</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Cholestasis - diagnosis Disease Progression Female Humans Incidence Lymphatic Metastasis - diagnosis Male Middle Aged Neoplasm Grading Neuroendocrine Tumors - mortality Neuroendocrine Tumors - pathology Neuroendocrine Tumors - surgery Pancreatectomy - methods Pancreatic Neoplasms - mortality Pancreatic Neoplasms - pathology Pancreatic Neoplasms - surgery Predictive Value of Tests Prospective Studies Retrospective Studies Surgery Survival Rate Treatment Outcome Tumor Burden World Health Organization |
| title | Outcomes of resected nonfunctional pancreatic neuroendocrine tumors: Do size and symptoms matter? |
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