RT Journal
A1 Norton JA, Harris EJ, Chen Y, et al
T1 PAncreatic endocrine tumors with major vascular abutment, involvement, or encasement and indication for resection
JF Archives of Surgery
JO Archives of Surgery
YR 2011
FD June 1
VO 146
IS 6
SP 724
OP 732
DO 10.1001/archsurg.2011.129
UL http://dx.doi.org/10.1001/archsurg.2011.129
AB Background 
    Surgery for pancreatic endocrine tumors (PETs) with blood vessel involvement is controversial.Hypothesis 
    Resection of PETs with major blood vessel involvement can be beneficial.Design 
    The combined databases of the National Institutes of Health and Stanford University hospitals were queried.Main Outcome Measures 
    Operation, pathologic condition, complications, and disease-free and overall survival.Results 
    Of 273 patients with PETs, 46 (17%) had preoperative computed tomography evidence of major vascular involvement. The mean size for the primary PET was 5.0 cm. The involved major vessel was as follows: portal vein (n = 20), superior mesenteric vein or superior mesenteric artery (n = 16), inferior vena cava (n = 4), splenic vein (n = 4), and heart (n = 2). Forty-two of 46 patients had a PET removed: 12 (27%) primary only, 30 (68%) with lymph nodes, and 18 (41%) with liver metastases. PETs were removed by either enucleation (n = 7) or resection (n = 35). Resections included distal or subtotal pancreatectomy in 23, Whipple in 10, and total in 2. Eighteen patients had concomitant liver resection: 10 wedge resection and 8 anatomic resections. Nine patients had vascular reconstruction: each had reconstruction of the superior mesenteric vein and portal vein, and 1 had concomitant reconstruction of the superior mesenteric artery. There were no deaths, but 12 patients had complications. Eighteen patients (41%) were immediately disease free, and 5 recurred with follow-up, leaving 13 (30%) disease-free long term. The 10-year overall survival was 60%. Functional tumors were associated with a better overall survival (P < .001), and liver metastases decreased overall survival (P < .001).Conclusion 
    These findings suggest that surgical resection of PETs with vascular abutment/invasion and nodal or distant metastases is indicated.