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Resection Versus Observation of Small Asymptomatic Nonfunctioning Pancreatic Neuroendocrine Tumors

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Management of asymptomatic, nonfunctioning small pancreatic neuroendocrine tumors (PNETs) is controversial because of their overall good prognosis, and the morbidity and mortality associated with pancreatic surgery. Our aim was to compare the outcomes of resection with expectant management of patients with small asymptomatic PNETs.

Methods

Retrospective review of patients with nonfunctioning asymptomatic PNETs < 2 cm that underwent resection or expectant management at the Tel-Aviv Medical Center between 2001 and 2018.

Results

Forty-four patients with small asymptomatic, biopsy-proven low-grade PNETs with a KI67 proliferative index < 3% were observed for a mean of 52.48 months. Gallium67DOTATOC-PET scan was completed in 32 patients and demonstrated uptake in the pancreatic tumor in 25 (78%). No patient developed systemic metastases. Two patients underwent resection due to tumor growth, and true tumor enlargement was evidenced in final pathology in one of them. Fifty-five patients underwent immediate resection. Significant complications (Clavien–Dindo grade ≥ 3) developed in 10 patients (18%), mostly due to pancreatic leak, and led to one mortality (1.8%). Pathological evaluation revealed lymphovascular invasion in 1 patient, lymph node metastases in none, and a Ki67 index ≥ 3% in 5. No case of tumor recurrence was diagnosed after mean follow-up of 52.8 months.

Conclusions

No patients with asymptomatic low-grade small PNETs treated by expectant management were diagnosed with regional or systemic metastases after a 52.8-month follow-up. Local tumor progression rate was 2.1%. Surgery has excellent long-term outcomes, but it harbors significant morbidity and mortality. Observation can be considered for selected patients with asymptomatic, small, low grade PNETs.

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Author information

Authors and Affiliations

  1. Unit of Liver Surgery Department of Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel

    Alex Barenboim, Guy Lahat, Ido Nachmany, Richard Nakache, Yaakov Goykhman, Lior Orbach, Joseph M. Klausner & Nir Lubezky

  2. Institute of Oncology, Tel-Aviv Medical Center, Tel Aviv, Israel

    Ravit Geva & Ido Wolf

  3. Department of Endocrinology, Tel-Aviv Medical Center, Tel Aviv, Israel

    Ester Osher

  4. Institute of Gastroenterology, Tel-Aviv Medical Center, Tel Aviv, Israel

    Erez Scapa

  5. Institute of Pathology, Tel-Aviv Medical Center, Tel Aviv, Israel

    Eli Brazowski

  6. Department of Internal Medicine “T”, Tel-Aviv Medical Center, (affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.), Tel Aviv, Israel

    Ofer Isakov

Authors
  1. Alex Barenboim
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  2. Guy Lahat
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  6. Ravit Geva
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  14. Nir Lubezky
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Contributions

Study concepts: Barenboim, Lubezky, Scapa, Osher, Geva, Nakache, Goykhman, Nachmany, Wolf, and Klausner

Study design: Barenboim, Lubezky, Scapa, Osher, Geva, Nakache, Goykhman, Nachmany, Wolf, and Klausner

Data acquisition: Barenboim, Lubezky, Orbach, Scapa, Osher, Geva, Nakache, Goykhman, Nachmany, Wolf, and Klausner

Quality control of data: Barenboim, Lubezky, Scapa, Osher, Geva, Nakache, Goykhman, Nachmany, Wolf, and Klausner

Data analysis and interpretation: Barenboim, Lubezky, Brazowski, Scapa, Osher, Geva, Nakache, Goykhman, Nachmany, Wolf, and Klausner

Statistical analysis: Isakov

Manuscript preparation: Barenboim, Lubezky, Scapa, Osher, Geva, Nakache, Goykhman, Nachmany, Wolf, and Klausner

Manuscript editing: Barenboim, Lubezky, Scapa, Osher, Geva, Nakache, Goykhman, Nachmany, Wolf, and Klausner

Manuscript review: Barenboim, Lubezky, Scapa, Osher, Geva, Nakache, Goykhman, Nachmany, Wolf, and Klausner.

Corresponding author

Correspondence to Nir Lubezky.

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Barenboim, A., Lahat, G., Nachmany, I. et al. Resection Versus Observation of Small Asymptomatic Nonfunctioning Pancreatic Neuroendocrine Tumors. J Gastrointest Surg 24, 1366–1374 (2020). https://doi.org/10.1007/s11605-019-04285-y

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  • DOI: https://doi.org/10.1007/s11605-019-04285-y

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