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. 2007 Apr;142(4):347-54.
doi: 10.1001/archsurg.142.4.347.

Evolving patterns in the detection and outcomes of pancreatic neuroendocrine neoplasms: the Massachusetts General Hospital experience from 1977 to 2005

Parsia A Vagefi  1 , Oswaldo Razo, Vikram Deshpande, Deborah J McGrath, Gregory Y Lauwers, Sarah P Thayer, Andrew L Warshaw, Carlos Fernández-Del Castillo
Affiliations

Evolving patterns in the detection and outcomes of pancreatic neuroendocrine neoplasms: the Massachusetts General Hospital experience from 1977 to 2005

Parsia A Vagefi et al. Arch Surg. 2007 Apr.

Abstract

Objective: To assess changing patterns in the detection and outcomes of pancreatic neuroendocrine neoplasms (PNENs).

Design: Retrospective review from May 21, 1977, through September 16, 2005.

Setting: Massachusetts General Hospital, a tertiary care center.

Patients: We evaluated 168 patients (51% male; mean age, 56 years) who underwent surgery for histologically confirmed PNENs.

Main outcome measures: Surgical outcomes, survival, and changes in presentation of PNENs in 2 time groups: 1977-1999 (77 patients) and 2000-2005 (91 patients).

Results: Ninety-eight patients (58.3%) had nonfunctioning PNENs, 86 of which were incidental. Insulinomas were the most common type of functional neoplasm (33.3%), followed by gastrinomas and glucagonomas; 12 patients (7.1%) had multiple endocrine neoplasia type 1. Of the neoplasms, 107 (63.7%) were located in the pancreatic body or tail. A pancreaticoduodenectomy was performed in 37 patients (22.0%), distal pancreatectomy was done in 88 (52.4%), and the rest had either middle segment pancreatectomy or enucleation. There were no operative deaths. We classified 76.8% of neoplasms as benign; of those classified as malignant, 25.6% had liver metastases. Of the patients, 10.1% received adjuvant therapy. Complete follow up was available in 90.5% of patients (mean, 63.3 months). Five- and 10-year actuarial survival rates were 77% and 62%, respectively. Incidentally discovered nonfunctioning neoplasms were significantly more frequent in the last 5 years (60.4% vs 40.3%; P = .007), with a trend toward smaller neoplasms (mean, 4.2 cm vs 5.6 cm; P = .19) and lesser likelihood of malignancy (21.8% vs 40.0%; P = .08).

Conclusions: We report a large single-center experience with PNENs. Increasing numbers of PNENs are being resected, largely owing to the incidental detection of nonfunctioning neoplasms. This may lead to the treatment of smaller and less malignant neoplasms.

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Figures

Figure 1
Figure 1
Resection of pancreatic neuroendocrine neoplasms by year for the period from 1977 to 2005 at Massachusetts General Hospital. Nonfunctional and functional neoplasms are indicated separately per year.
Figure 2
Figure 2
Classification of 168 resected pancreatic neuroendocrine neoplasms. Of the nonfunctional neoplasms, 87.8% were discovered incidentally. ACTH indicates adrenocorticotropic hormone; VIP, vasoactive intestinal polypeptide.
Figure 3
Figure 3
Location of 168 pancreatic neuroendocrine neoplasms.
Figure 4
Figure 4
Long-term follow-up of 168 patients who underwent pancreatic neuroendocrine neoplasm (PNEN) resection.
Figure 5
Figure 5
Survival rates for the entire study cohort of 168 patients with pancreatic neuroendocrine neoplasms.
Figure 6
Figure 6
Comparison of survival rates among patients with pancreatic neuroendocrine neoplasms for benign and malignant neoplasms (A) as well as functional and nonfunctional neoplasms (B).
See this image and copyright information in PMC

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