Haynes Alex B, Deshpande Vikram, Ingkakul Thun, Vagefi Parsia A, Szymonifka Jackie, Thayer Sarah P, Ferrone Cristina R, Wargo Jennifer A, Warshaw Andrew L, Fernández-del Castillo Carlos
Department of Surgery, Massachusetts General Hospital, Wang Ambulatory Care Center 460, 15 Parkman St, Boston, MA 02114, USA.
Arch Surg. 2011 May;146(5):534-8. doi: 10.1001/archsurg.2011.102.
To describe the characteristics and outcomes after resection of incidentally discovered, nonfunctioning pancreatic endocrine tumors (PETs).
Case series.
Academic hospital.
Consecutive patients with an incidentally identified, nonfunctioning PET resected from May 1, 1977, through July 31, 2009.
Operative morbidity and survival after resection.
A total of 139 patients with median age of 56 years (range, 21-85 years) underwent resection; tumor size ranged from 0.4 to 17.0 cm, with median size of 3.0 cm. No perioperative deaths were reported. Sixty-one patients (43.9%) experienced a perioperative complication. Twenty-six tumors (18.7%) were classified as benign, 39 (28.1%) as malignant, and 72 (51.8%) as uncertain. We were unable to confidently classify 2 tumors due to lack of information regarding mitotic rate in the pathology report. Complete follow-up was available for 112 patients (80.6%) (median, 34.2 months). Five-year actuarial survival rates were 88.8% for patients with benign disease, 92.5% for patients with tumors of uncertain biology, and 49.8% for those with malignant tumors (P = .01). Late metastasis, tumor recurrence, or disease progression were seen in 1 patient (3.8%) with tumors initially classified as benign, 8 patients (11.1%) with uncertain tumors, and 15 patients (38.5%) with tumors classified as malignant (P < .001). Of the 39 patients with tumors 2 cm or smaller, 3 (7.7%) had late metastases or recurrence. When compared with patients with symptomatic, nonfunctioning PETs, no large difference was observed in tumor size, patient age, disease, or survival.
Incidentally detected, nonfunctioning PETs can display aggressive behavior, even when small. Although patients with malignant disease had diminished survival and increased rates of recurrence, benign histologic findings did not eliminate the possibility of progression. Patients with incidentally discovered, nonfunctioning PETs should undergo tumor resection and careful postoperative surveillance, even if surgical pathologic findings suggest benign disease.
描述偶然发现的无功能性胰腺内分泌肿瘤（PETs）切除术后的特征及结果。
病例系列研究。
学术型医院。
1977年5月1日至2009年7月31日期间连续入选的偶然发现的无功能性PETs患者，均接受了手术切除。
切除术后的手术并发症及生存率。
共有139例患者接受了手术切除，中位年龄56岁（范围21 - 85岁）；肿瘤大小为0.4至17.0 cm，中位大小为3.0 cm。未报告围手术期死亡病例。61例患者（43.9%）出现围手术期并发症。26个肿瘤（18.7%）被分类为良性，39个（28.1%）为恶性，72个（51.8%）为不确定。由于病理报告中缺乏有丝分裂率的信息，我们无法确定分类2个肿瘤。112例患者（80.6%）获得了完整随访（中位随访时间34.2个月）。良性疾病患者的5年精算生存率为88.8%，生物学行为不确定的肿瘤患者为92.5%，恶性肿瘤患者为49.8%（P = 0.01）。最初分类为良性的肿瘤患者中有1例（3.8%）出现晚期转移、肿瘤复发或疾病进展，生物学行为不确定的肿瘤患者中有8例（11.1%），分类为恶性的肿瘤患者中有15例（38.5%）（P < 0.001）。在39例肿瘤直径2 cm或更小的患者中，3例（7.7%）出现晚期转移或复发。与有症状的无功能性PETs患者相比，在肿瘤大小、患者年龄、疾病或生存率方面未观察到显著差异。
偶然发现的无功能性PETs即使体积小也可能表现出侵袭性。虽然恶性疾病患者生存率降低且复发率增加，但良性组织学结果并不能排除疾病进展的可能性。偶然发现的无功能性PETs患者即使手术病理结果提示为良性疾病，也应接受肿瘤切除及仔细的术后监测。
