TY - JOUR
T1 - Therapeutic Strategies for Advanced Pancreatic Neuroendocrine Tumors with Segmental Portal Hypertension
AU - Dumont, F.
AU - Goudard, Y.
AU - Caramella, C.
AU - Goéré, D.
AU - Baudin, E.
AU - Elias, D.
N1 - Publisher Copyright:
© 2015 Société Internationale de Chirurgie.
PY - 2015/8/22
Y1 - 2015/8/22
N2 - Abstract Background: Pancreatic neuroendocrine tumors (PNET) locally advanced may lead to significant local symptoms especially segmental portal hypertension (SPH) with risk of bleeding. The aim of our study was to evaluate the role of SPH on the PNET management in an expert center. Methods: Forty-two patients treated for locally advanced PNET with SPH between January 1984 and December 2012 were retrospectively analyzed. Results: The median age was 55 years (25-75). The median tumor size was 7.5 cm (3-20). Thirty four (80.9 %) patients were metastatic mainly in the liver (n = 33, 79 %) with a frequent (n = 16, 38.1 %) involvement >20 %. The surgery was impossible because of SPH in 7 (16.6 %) cases. Pancreatic resection was performed in 28 (66.7 %) cases by distal pancreatectomy. Neoadjuvant chemotherapy (n = 24, 57 %) had no impact on SPH with no modification of collateral circulation. Among operated on patients, complete macroscopic resection was obtained in 19 (67.8 %) patients. The mortality and severe morbidity rate was respectively 3.6 and 18 %. Five year overall survival (OS) was similar in operated and no operated patients. (61 %; p = 0.64). The 5-year OS was 77.9 or 55.4 % in patients who underwent a complete or incomplete macroscopic resection of primary and metastases, respectively. Conclusion: PNET resection associated with SPH is feasible with a low morbimortality. SPH was not improved by chemotherapy. Prolonged survival was observed after complete macroscopic resection.
AB - Abstract Background: Pancreatic neuroendocrine tumors (PNET) locally advanced may lead to significant local symptoms especially segmental portal hypertension (SPH) with risk of bleeding. The aim of our study was to evaluate the role of SPH on the PNET management in an expert center. Methods: Forty-two patients treated for locally advanced PNET with SPH between January 1984 and December 2012 were retrospectively analyzed. Results: The median age was 55 years (25-75). The median tumor size was 7.5 cm (3-20). Thirty four (80.9 %) patients were metastatic mainly in the liver (n = 33, 79 %) with a frequent (n = 16, 38.1 %) involvement >20 %. The surgery was impossible because of SPH in 7 (16.6 %) cases. Pancreatic resection was performed in 28 (66.7 %) cases by distal pancreatectomy. Neoadjuvant chemotherapy (n = 24, 57 %) had no impact on SPH with no modification of collateral circulation. Among operated on patients, complete macroscopic resection was obtained in 19 (67.8 %) patients. The mortality and severe morbidity rate was respectively 3.6 and 18 %. Five year overall survival (OS) was similar in operated and no operated patients. (61 %; p = 0.64). The 5-year OS was 77.9 or 55.4 % in patients who underwent a complete or incomplete macroscopic resection of primary and metastases, respectively. Conclusion: PNET resection associated with SPH is feasible with a low morbimortality. SPH was not improved by chemotherapy. Prolonged survival was observed after complete macroscopic resection.
UR - http://www.scopus.com/inward/record.url?scp=84937524951&partnerID=8YFLogxK
U2 - 10.1007/s00268-015-3030-8
DO - 10.1007/s00268-015-3030-8
M3 - Article
C2 - 25804547
AN - SCOPUS:84937524951
SN - 0364-2313
VL - 39
SP - 1974
EP - 1980
JO - World Journal of Surgery
JF - World Journal of Surgery
IS - 8
M1 - 3030
ER -