Outcome after laparoscopic enucleation for non-functional neuroendocrine pancreatic tumours

Abstract

Background: Non-functional endocrine pancreatic tumours (NPT) of more than 2 cm have an increased risk of malignancy. The aim of the present study was: (i) to define the guidelines for laparoscopic enucleation (LapEn) in patients with a non-functional NPT ≤3 cm in diameter; (ii) to evaluate pancreas-related complications; and (iii) to present the long-term outcome.

Methods: Between April 1998 and September 2010, 30 consecutive patients underwent laparoscopic surgery for a non-functional NPT (median age 56.5 years, range 44-83). Only 13 patients with tumours ≤3 cm in size underwent LapEn. Local lymph node dissection to exclude lymph node involvement was performed in all patients.

Results: The median tumour size, operative time and blood loss were 2.8 cm (range 2.8-3), 130 min (range 90-280) and 220 ml (range 120-300), respectively. A pancreatic fistula occurred in five patients: International Study Group of Pancreatic Fistula (ISGPF) A in two patients and ISGPF B in three patients. The median follow-up was 48 months (12-144). Three patients with well-differentiated carcinoma are free of disease 2, 3 and 4 years after LapEn and a regional lymphadenectomy. One patient, 5 years after a LapEn, presented with lymph node and liver metastases.

Conclusions: The present study confirms the technical feasibility and acceptable morbidity associated with LapEn. Intra-operative lymph node sampling and frozen-section examination should be performed at the time of LapEn; when a malignancy is confirmed, oncologically appropriate lymph node dissection should be performed.

Figure 1

Complete laparoscopic enucleation of a tumour located in the pancreatic head. Caution should be taken to avoid injury of the Wirsung duct. Lymph node sampling of the areas around the hepatic artery (8), anterior pancreatoduodenal (17) and superior mesenteric vein (14); numbers correspond to areas according to the Japanese Pancreas Society

Figure 2

Laparoscopic enucleation of tumours located in the body of the pancreas. Depending on the location of the tumour, lymph node sampling along the splenic artery (11) and at the inferior border of the pancreas (18); numbers correspond to areas according to the Japanese Pancreas Society