Uccelli Fara, Gavazzi F, Capretti G, Virdis M, Montorsi M, Zerbi A
Pancreatic Surgery Unit-Hospital Health Direction, Humanitas Research Hospital, Rozzano, MI, Italy.
Chancellor of Humanitas University, Chief of Department of Surgery, Humanitas Research Hospital, Rozzano, Italy.
Updates Surg. 2016 Sep;68(3):313-319. doi: 10.1007/s13304-016-0400-1. Epub 2016 Oct 5.
Enucleation (EN) and middle pancreatectomy (MP) have been proposed as a treatment for G1 and G2 pancreatic neuroendocrine tumors (PNET). The aim of this study is to analyze the outcomes of parenchyma-sparing surgery (PSS) for PNET in an Italian high-volume center. All patients with a histological diagnosis of PNET who underwent surgical resection in our center between January 2010 and January 2016 were included in the study. Demographic, perioperative, and discharge data were collected in a prospective database. Follow-up was considered until March 31, 2016. 99 patients were included. PSS was performed in 22 cases (22.2 %), 18 EN (82 %), and 4 MP (18 %). 89.8 % patients were staged with CT scan, 69.6 % with endoscopic ultrasonography, 48.4 % with MRI, and 47.4 % with 68Ga-PET. Pre-operative histological diagnosis was obtained in 68.6 %. Most of PSS tumors were G1 (n = 15; 68 %) and there were no G3. Nodal sampling was performed in every PSS. Only two patients showed nodal metastatic disease. The median post-operative length of stay was 7 days after PSS. Eleven (50 %) of these patients developed a complication; two (18.2 %) were major complications. Pancreatic fistula developed in ten patients (45.5 %); two (20 %) were type B. There were no type C fistula and no re-operations after PSS. Readmission rate was 9 %. All patients submitted to PSS are alive and free of recurrence. PSS is a safe technique for G1 and G2 PNETs, but it has to be conducted in experienced centers and an extensive nodal sampling and a long follow-up are required for the best oncologic outcome.
剜除术（EN）和中段胰腺切除术（MP）已被提议作为G1和G2级胰腺神经内分泌肿瘤（PNET）的一种治疗方法。本研究的目的是分析在意大利一家高手术量中心对PNET进行保留实质手术（PSS）的结果。2010年1月至2016年1月期间在我们中心接受手术切除且经组织学诊断为PNET的所有患者均纳入本研究。人口统计学、围手术期和出院数据收集于前瞻性数据库。随访至2016年3月31日。共纳入99例患者。22例（22.2%）行PSS，其中18例（82%）行EN，4例（18%）行MP。89.8%的患者通过CT扫描分期，69.6%通过内镜超声分期，48.4%通过MRI分期，47.4%通过68Ga-PET分期。68.6%的患者获得了术前组织学诊断。大多数PSS肿瘤为G1级（n = 15；68%），无G3级。每个PSS病例均进行了淋巴结采样。仅2例患者出现淋巴结转移疾病。PSS术后中位住院时间为7天。这些患者中有11例（50%）发生了并发症；2例（18.2%）为严重并发症。10例患者（45.5%）发生胰瘘；2例（20%）为B型。无C型瘘，PSS术后无再次手术。再入院率为9%。所有接受PSS的患者均存活且无复发。PSS对于G1和G2级PNET是一种安全的技术，但必须在有经验的中心进行，并且为了获得最佳肿瘤学结果，需要进行广泛的淋巴结采样和长期随访。
