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Prospective study of aggressive resection of metastatic pancreatic endocrine tumors
S E Carty1, R T Jensen, J A Norton
1Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
Background:
Because metastatic pancreatic endocrine tumors (MPET) have a poor prognosis, 17 patients with potentially resectable MPET were prospectively studied to define the efficacy of aggressive resection.
Methods:
Patients underwent resection when the full extent of MPET was deemed operable after imaging studies were obtained. Two patients underwent three reoperations for recurrent tumor.
Results:
MPET were completely excised in 16 of 20 cases by major resections of liver, viscera, and nodes, with no operative mortality. Survival was 87% at 2 years and 79% at 5 years with mean follow-up of 3.2 years. Median imaging disease-free interval was 1.8 years, and four of 17 patients remain biochemically cured. After aggressive resection patients with MPET limited in extent had higher survival than patients with extensive MPET (p < 0.019). In a nonrandomized cohort of 25 patients with inoperable tumor, survival was 60% at 2 years and 28% at 5 years.
Conclusions:
In select patients MPET can be resected safely with a favorable outcome; most patients will experience recurrence, but some may be cured. Resection of extensive MPET does not appear to improve survival. Resection of limited MPET should be considered as life-extending and potentially curative therapy.
Insights
Aggressive resection of metastatic pancreatic endocrine tumors (MPET) is safe in select patients, offering potential cure or life extension. However, extensive MPET resection may not improve survival outcomes.
Area of Science:
- Surgical Oncology
- Endocrinology
- Gastroenterology
Background:
- Metastatic pancreatic endocrine tumors (MPET) are associated with a poor prognosis.
- Limited data exists on the efficacy of aggressive surgical resection for potentially resectable MPET.
Purpose of the Study:
- To prospectively evaluate the efficacy and safety of aggressive surgical resection in patients with potentially resectable MPET.
- To compare survival outcomes between patients with limited versus extensive MPET.
Main Methods:
- Prospective study of 17 patients with potentially resectable MPET.
- Surgical resection performed after imaging confirmed operability.
- Inclusion of major resections involving liver, viscera, and lymph nodes.
Main Results:
- Complete tumor excision achieved in 16 of 20 cases with no operative mortality.
- 5-year survival rate of 79% for patients undergoing resection.
- Higher survival rates observed in patients with limited MPET compared to extensive MPET (p < 0.019).
- Comparison with a cohort of 25 patients with inoperable tumors showed significantly lower survival rates.
Conclusions:
- Aggressive resection of MPET is safe and offers favorable outcomes in select patients.
- While recurrence is common, some patients achieve a cure.
- Resection of limited MPET should be considered for life extension and potential cure.
- Resection of extensive MPET does not appear to improve survival.