Solodkiy V A, Kriger A G, Akhaladze G G, Goev A A, Goncharov S V, Gorin D S, Zagainov V E, Kuznetsov N S, Kuchin D M, Latkina N V, Lysanyuk M V, Maistrenko N A, Martirosyan T A, Romashchenko P N, Shuinova E A, Yukina M Yu
Russian Research Center for Radiology, Moscow, Russia.
Vishnevsky National Medical Research Center for Surgery, Moscow, Russia.
Khirurgiia (Mosk). 2023(2):13-20. doi: 10.17116/hirurgia202302113.
To evaluate the immediate results of enucleation of pancreatic neuroendocrine tumors (pNETs).
The results of enucleation of pancreatic neuroendocrine tumors (pNETs) were analyzed in 95 patients between 2016 and 2021. Functioning tumors (mean size 16.8 mm) were found in 70 patients, non-functioning (mean size 25 mm) - in 25 patients. Intraparenchymal tumors were found in 48 people, extraorganic lesion - in 47 patients.
There were 262 patients with pNETs who underwent various surgeries between 2016 and 2021. Various resections were performed in 167 (63.8%) cases, enucleations - in 95 (36.2%) patients. Traditional surgical approach was used in 65 patients. Pancreatic fistula occurred in 21 patients (type B - 17, type C - 4), while arrosive bleeding occurred in 6 patients with unfavorable outcomes in 2 cases. Minimally invasive surgeries were performed in 30 patients. Eight patients with intraparenchymal tumors required conversion to open surgery. Type B pancreatic fistula occurred in 5 patients that led to arrosive bleeding in 2 cases (hemostasis was provided by endovascular method). Comparison of intraparenchymal and extraorgan tumors regarding the incidence of pancreatic fistula revealed odds ratio 5.26 (95% CI 1.5355; 18.0323, =0.0041). Postoperative mortality was 2.1%.
Enucleation is advisable for highly differentiated pancreatic neuroendocrine tumors up to 2 cm. Minimally invasive enucleation is indicated for extraorgan tumors. Intraparenchymal tumors significantly increase the risk of postoperative complications.
评估胰腺神经内分泌肿瘤（pNETs）剜除术的近期效果。
分析了2016年至2021年间95例胰腺神经内分泌肿瘤（pNETs）剜除术的结果。70例患者为功能性肿瘤（平均大小16.8mm），25例为无功能性肿瘤（平均大小25mm）。48例为实质内肿瘤，47例为器官外病变。
2016年至2021年间，有262例pNETs患者接受了各种手术。167例（63.8%）进行了各种切除术，95例（36.2%）进行了剜除术。65例患者采用传统手术方法。21例患者发生胰瘘（B型-17例，C型-4例），6例患者发生侵蚀性出血，2例预后不良。30例患者进行了微创手术。8例实质内肿瘤患者需要转为开放手术。5例患者发生B型胰瘘，其中2例导致侵蚀性出血（通过血管内方法止血）。实质内肿瘤和器官外肿瘤在胰瘘发生率方面的比较显示优势比为5.26（95%CI 1.5355；18.0323，P=0.0041）。术后死亡率为2.1%。
对于直径达2cm的高分化胰腺神经内分泌肿瘤，剜除术是可取的。对于器官外肿瘤，建议采用微创剜除术。实质内肿瘤显著增加术后并发症的风险。
