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Robotic Enucleation of an Intra-Pancreatic Insulinoma in the Pancreatic Head
Published on: January 3, 2020
Non-functioning pancreatic endocrine tumors: eleven-year experience in a single institute
George-Panagiotis Fragulidis1, Michael-Kyriakos Derpapas, Antonios Vezakis
12nd Department of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece.
Purpose:
Non-functioning pancreatic endocrine tumors (NF-PETs) comprise the majority of pancreatic endocrine tumors. We present our experience from the management of 18 patients with NF-PET.
Methods:
From May 2002 to June 2013, 18 patients were admitted in our hospital for the management of NF-PETs. We analyzed their clinical presentation, preoperative evaluation, surgical and postoperative management and the outcome.
Results:
The tumor was located in the pancreatic head in 13 (72%) patients and in the body and tail of the pancreas in the remaining 5 (28%). Four patients (22%) had stage IIIa, 7 (39%) stage IIIb and 7 (39%) stage IV. Twelve (67%) patients with pancreatic head tumor underwent pancreatoduodenectomy (PD). In one case (5%), the tumor was deemed unresectable and the remaining 5 (28%) patients underwent distal pancreatectomy and splenectomy (DPSP). Four (22%) patients with unilobar metastatic liver disease underwent hemihepatectomy or segmentectomy. Perioperative mortality was 0%. Postoperatively, all stage IV patients received peptide receptor radionuclide treatment (PRRT). The 5-year overall survival rate was 61%, with a median survival of 71 months, whereas the 5-year overall survival rate after diagnosis of hepatic metastases was 45%.
Conclusion:
Surgical resection is the gold standard for the treatment of NF-PETs. A formal resection appears to be the standard procedure when malignancy is verified or suspected. Aggressive surgery should be undertaken in patients with locally advanced or metastatic NF-PETs, as it may prolong survival. In stage IV patients, intra-arterial PRRT, after super-selective catheterization of the hepatic artery, is a promising therapeutic modality.
