Evolving patterns in the detection and outcomes of pancreatic neuroendocrine neoplasms

The Massachusetts General Hospital experience from 1977 to 2005

Parsia A. Vagefi, Oswaldo Razo, Vikram Deshpande, Deborah J. McGrath, Gregory Y. Lauwers, Sarah P Thayer, Andrew L. Warshaw, Carlos Fernández-Del Castillo

Research output: Contribution to journalArticle

143 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)347-353
Number of pages7
JournalArchives of Surgery
Volume142
Issue number4
DOIs
StatePublished - Apr 1 2007

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Pancreatic Neoplasms
General Hospitals
Neoplasms
Pancreatectomy
Glucagonoma
Gastrinoma
Multiple Endocrine Neoplasia Type 1
Insulinoma
Pancreaticoduodenectomy
Tertiary Care Centers
Survival Rate
Outcome Assessment (Health Care)
Neoplasm Metastasis
Survival
Liver
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Evolving patterns in the detection and outcomes of pancreatic neuroendocrine neoplasms : The Massachusetts General Hospital experience from 1977 to 2005. / Vagefi, Parsia A.; Razo, Oswaldo; Deshpande, Vikram; McGrath, Deborah J.; Lauwers, Gregory Y.; Thayer, Sarah P; Warshaw, Andrew L.; Fernández-Del Castillo, Carlos.

In: Archives of Surgery, Vol. 142, No. 4, 01.04.2007, p. 347-353.

Research output: Contribution to journalArticle

Vagefi, Parsia A. ; Razo, Oswaldo ; Deshpande, Vikram ; McGrath, Deborah J. ; Lauwers, Gregory Y. ; Thayer, Sarah P ; Warshaw, Andrew L. ; Fernández-Del Castillo, Carlos. / Evolving patterns in the detection and outcomes of pancreatic neuroendocrine neoplasms : The Massachusetts General Hospital experience from 1977 to 2005. In: Archives of Surgery. 2007 ; Vol. 142, No. 4. pp. 347-353.
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abstract = "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.",
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