Management and surveillance of non-functional pancreatic neuroendocrine tumours: Retrospective review

/Objective. To determine the outcomes of a non-operative management approach for sporadic, small, non-functional pancreatic neuroendocrine tumours. A retrospective chart review of patients with non-functional pancreatic neuroendocrine tumours initially managed non-operatively at a single institution was performed. Patients were identified through a search of radiologic reports, and individuals with ≥2 cross-sectional imaging studies performed >6 months apart from Jan. 1, 2000 to Dec. 31, 2013 were included. Data on tumour size, radiologic characteristics at diagnosis, interval radiologic growth, and surgical outcomes were recorded. Over the thirteen-year study period, 95 patients met inclusion criteria and were followed radiologically for a median of 36 months (18–69 months). Median initial tumour size on first imaging was 14.0 mm (IQR 10–19 mm). Median overall tumour growth rate was 0.03 mm/month (IQR: 0.00–0.14 mm/month). There was no significant relationship between initial tumour size and growth rate for tumours ≤ 2 cm or for lesions between 2 and 4 cm. Thirteen (14%) patients initially managed non-operatively underwent resection during the follow-up period. Reasons for surgery included interval tumour growth, patient anxiety or preference, or diagnostic uncertainty. Median time to surgery was 14 months (IQR 8–19 months). No patients progressed beyond resectability or developed metastatic disease during the observation period. For patients with sporadic, small, non-functional pancreatic neuroendocrine tumours, radiologic surveillance appears to be a safe initial approach to management.