Multivisceral resection of pancreatic neuroendocrine tumours: a report of two cases

Abstract

Pancreatic neuroendocrine tumours (pNETs) are rare and surgical resection offers the only possibility of cure for localised disease. The role of surgery in the setting of locally advanced and metastatic disease is more controversial. Emerging data suggests that synchronous surgical resection of pancreas and liver may be associated with increased survival. We report two cases of synchronous, one stage multivisceral resections for pNET and associated reconstruction. We highlight the technical issues involved in such extensive resections and demonstrate that one stage multivisceral operations can be achieved safely.

Figure 1

Macroscopic view of extended right hepatectomy specimen (Case 1).

Figure 2

Operative resection bed following removal of right liver and head of pancreas tumours (Case 1).

Figure 3

a: CT demonstrating pancreatic mass with superior mesenteric/portal vein encasement and associated liver metastasis (Case 2); b: CT demonstrating right liver metastasis (post embolization; Case 2).

Figure 4

a: Macroscopic view of en bloc primary tumour resection specimen (Case 2); b: pancreatic tumour invasion of lesser sac and posterior stomach wall (Case 2).

Figure 5

Illustration depicting vascular and enteric reconstruction post resection (Case 2).

Figure 6

a: at low magnification the pancreatic tumour displayed a typical trabecular architecture; b: at higher power the typical neuroendocrine nuclear features characterised by dispersed chromatin are observed; c: Immunohistochemistry for Chromogranin was diffusely strongly positive; d: Immunohistochemistry for Ki-67 demonstrated a proliferative index of 2% (original magnifications a: 100×, b, c, d: 400×; Case 2).