Chirurgia Generale B (Pancreas Unit), Department of Surgery, University of Verona, Policlinico GB Rossi, Verona, Italy.
Ann Surg Oncol. 2010 Jun;17(6):1621-7. doi: 10.1245/s10434-010-0949-8. Epub 2010 Feb 17.
Parenchyma-preserving resections (PPRs), including enucleation and middle pancreatectomy (MP), are accepted procedures for insulinomas, but their role in the treatment of nonfunctioning pancreatic endocrine tumors (NF-PETs) is debated. The aim of this study was to evaluate perioperative and long-term outcomes after PPRs for NF-PETs.
All patients who underwent PPRs for NF-PETs between 1990 and 2005 were included. Patients with multiple endocrine neoplasia type 1 were excluded.
Overall, 50 patients (23 men, 27 women, median age 59 years) underwent 26 enucleations and 24 MP. A total of 58% of NF-PETs were incidentally discovered. Median size of the tumors was 13.5 mm with no preoperative suspicion of malignancy in all patients. Overall morbidity and pancreatic fistula rates were 58 and 50%, respectively. Reoperation rate was 4%, with no mortality. Postoperative complications were higher in the MP group. At pathology, there were 34 (68%) benign lesions, 13 (26%) neoplasms of uncertain behavior, and 3 (6%) well-differentiated carcinomas. Forty-one patients (82%) had tumors < or =2 cm in size. Only eight patients (16%) had at least one lymph node removed. After a median follow-up of 58 months, no patient died of disease. Overall, four patients (8%) experienced tumor recurrence after a mean of 68 months. The incidence of exocrine/endocrine insufficiency was 8%.
PPRs are generally safe and effective procedures for treating small NF-PETs. However, better selection criteria must be identified, and lymph node sampling should be performed routinely to avoid understaging. Long-term follow-up evaluation (>5 years) is of paramount importance given the possible risk of late recurrence.
保胰腺实质切除术（PPR），包括肿瘤剜除术和胰体尾切除术（MP），已被广泛应用于胰岛素瘤的治疗，但在无功能性胰腺神经内分泌肿瘤（NF-PET）的治疗中其作用仍存在争议。本研究旨在评估 PPR 治疗 NF-PET 的围手术期和长期结果。
纳入 1990 年至 2005 年间接受 PPR 治疗的 NF-PET 患者。排除多发性内分泌肿瘤 1 型患者。
共 50 例患者（23 例男性，27 例女性，中位年龄 59 岁）接受了 26 例肿瘤剜除术和 24 例 MP。58%的 NF-PET 为偶然发现。肿瘤的中位大小为 13.5mm，所有患者术前均未怀疑恶性。总的发病率和胰瘘发生率分别为 58%和 50%。再次手术率为 4%，无死亡病例。MP 组术后并发症发生率较高。病理检查结果显示，34 例（68%）为良性病变，13 例（26%）为行为不确定的肿瘤，3 例（6%）为分化良好的癌。41 例患者（82%）肿瘤直径≤2cm。仅 8 例患者（16%）切除了至少一个淋巴结。中位随访 58 个月后，无患者死于疾病。总的来说，4 例患者（8%）在平均 68 个月后出现肿瘤复发。内分泌/外分泌功能不全的发生率为 8%。
PPR 是治疗小 NF-PET 的一种安全有效的方法。但是，必须确定更好的选择标准，并且应常规进行淋巴结取样，以避免分期不足。鉴于可能存在的晚期复发风险，长期随访评估（>5 年）至关重要。
