TY - JOUR
T1 - Evolving patterns in the detection and outcomes of pancreatic neuroendocrine neoplasms
T2 - The Massachusetts General Hospital experience from 1977 to 2005
AU - Vagefi, Parsia A.
AU - Razo, Oswaldo
AU - Deshpande, Vikram
AU - McGrath, Deborah J.
AU - Lauwers, Gregory Y.
AU - Thayer, Sarah P.
AU - Warshaw, Andrew L.
AU - Fernández-Del Castillo, Carlos
PY - 2007/4
Y1 - 2007/4
N2 - Objective: To assess changing patterns in the detection and outcomes of pancreatic neuroendocrine neoplasms (PNENs). Design: Retrospective review from May 21, 1977, through September 16, 2005. Setting: Massachusetts General Hospital, a tertiary care center. Patients: We evaluated 168 patients (51% male; mean age, 56 years) who underwent surgery for histologically confirmed PNENs. Main Outcome Measures: Surgical outcomes, survival, and changes in presentation of PNENs in 2 time groups: 1977-1999 (77 patients) and 2000-2005 (91 patients). Results: Ninety-eight patients (58.3%) had nonfunctioning PNENs, 86 of which were incidental. Insulinomas were the most common type of functional neoplasm (33.3%), followed by gastrinomas and glucagonomas; 12 patients (7.1%) had multiple endocrine neoplasia type 1. Of the neoplasms, 107 (63.7%) were located in the pancreatic body or tail. A pancreaticoduodenectomy was performed in 37 patients (22.0%), distal pancreatectomy was done in 88 (52.4%), and the rest had either middle segment pancreatectomy or enucleation. There were no operative deaths. We classified 76.8% of neoplasms as benign; of those classified as malignant, 25.6% had liver metastases. Of the patients, 10.1% received adjuvant therapy. Complete follow up was available in 90.5% of patients (mean, 63.3 months). Five- and 10-year actuarial survival rates were 77% and 62%, respectively. Incidentally discovered nonfunctioning neoplasms were significantly more frequent in the last 5 years (60.4% vs 40.3%; P=.007), with a trend toward smaller neoplasms (mean, 4.2 cm vs 5.6 cm; P=.19) and lesser likelihood of malignancy (21.8% vs 40.0%; P=.08). Conclusions: We report a large single-center experience with PNENs. Increasing numbers of PNENs are being resected, largely owing to the incidental detection of non-functioning neoplasms. This may lead to the treatment of smaller and less malignant neoplasms.
AB - Objective: To assess changing patterns in the detection and outcomes of pancreatic neuroendocrine neoplasms (PNENs). Design: Retrospective review from May 21, 1977, through September 16, 2005. Setting: Massachusetts General Hospital, a tertiary care center. Patients: We evaluated 168 patients (51% male; mean age, 56 years) who underwent surgery for histologically confirmed PNENs. Main Outcome Measures: Surgical outcomes, survival, and changes in presentation of PNENs in 2 time groups: 1977-1999 (77 patients) and 2000-2005 (91 patients). Results: Ninety-eight patients (58.3%) had nonfunctioning PNENs, 86 of which were incidental. Insulinomas were the most common type of functional neoplasm (33.3%), followed by gastrinomas and glucagonomas; 12 patients (7.1%) had multiple endocrine neoplasia type 1. Of the neoplasms, 107 (63.7%) were located in the pancreatic body or tail. A pancreaticoduodenectomy was performed in 37 patients (22.0%), distal pancreatectomy was done in 88 (52.4%), and the rest had either middle segment pancreatectomy or enucleation. There were no operative deaths. We classified 76.8% of neoplasms as benign; of those classified as malignant, 25.6% had liver metastases. Of the patients, 10.1% received adjuvant therapy. Complete follow up was available in 90.5% of patients (mean, 63.3 months). Five- and 10-year actuarial survival rates were 77% and 62%, respectively. Incidentally discovered nonfunctioning neoplasms were significantly more frequent in the last 5 years (60.4% vs 40.3%; P=.007), with a trend toward smaller neoplasms (mean, 4.2 cm vs 5.6 cm; P=.19) and lesser likelihood of malignancy (21.8% vs 40.0%; P=.08). Conclusions: We report a large single-center experience with PNENs. Increasing numbers of PNENs are being resected, largely owing to the incidental detection of non-functioning neoplasms. This may lead to the treatment of smaller and less malignant neoplasms.
UR - http://www.scopus.com/inward/record.url?scp=34247868093&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34247868093&partnerID=8YFLogxK
U2 - 10.1001/archsurg.142.4.347
DO - 10.1001/archsurg.142.4.347
M3 - Article
C2 - 17438169
AN - SCOPUS:34247868093
SN - 0004-0010
VL - 142
SP - 347
EP - 353
JO - Archives of Surgery
JF - Archives of Surgery
IS - 4
ER -