Pancreatic Neuroendocrine Tumors: How Much Surgery is Safe?

Background: Neuroendocrine tumors of the pancreas (pNET) are rare. Often the patients are asymptomatic for a long time and present late with metastasized disease. Although there are guidelines for the treatment of these tumors, there is no clear consensus whether the resection of liver metastases may be combined with the primary tumor. Method: We retrospectively analyzed the patients operated at our institution between 1/2003 and 12/2012. The patients were analyzed for demographic and clinical data, surgical treatment, tumor size and stage, histology, complications, survival and tumor recurrence over time. Results: We analyzed 53 patients, 23 females, 30 males. Patients with a one-step surgical approach to pancreas and liver had similar morbidity and mortality compared to patients with disease confined to the pancreas. The primary tumors were smaller in tumors confined to the pancreas. Angioinvasion as well as positive lymph nodes were strongly correlated with synchronous or metachronous liver metastases. Progression free survival was shorter in patients with primary metastasized disease. Conclusion: The treatment of pNET is challenging. The surgical approach should be tailored to the patient’s general condition. Patients benefit from extended and combined resections even in metastasized or locally advanced situations. Combined pancreatic and hepatic surgery may be performed safely.