Reconsideration of operative indications in pancreatic neuroendocrine neoplasms

Abstract

Abstract BACKGROUND The incidence of pancreatic neuroendocrine neoplasm (PNEN) has been increasing. Resection is typically indicated for PNEN, regardless of its size; however, the indications for its resection are controversial. This study aimed to evaluate the treatment results of surgical resection of PNEN at our institute. METHODS In this single-center, retrospective, case-control study, 87 patients who underwent PNEN resection and 17 patients with PNEN who did not undergo surgical resection between 1993 and 2020 were included in this study. Clinical characteristics and outcomes were reviewed and statistically compared. Survival was also estimated for the patients in each cohort. RESULTS Seventeen patients who underwent resection (20%) had lymph node metastasis. Tumor measuring ≥ 2.0 cm in size and multiple lesions were identified as independent predictors for lymph node metastasis (odds ratio [OR] 17.3, 95% confidence interval [CI] 3.0–100.0, p = 0.001 and OR 8.7, 95% CI 1.5–52.0, p = 0.018, respectively). There was a significant difference in the survival curves depending on the presence or absence of lymph node metastasis (5-year overall survival: 74.7% vs. 94.3%, p < 0.001; 5-year recurrence-free survival: 66.3% vs. 93.6%, p < 0.001). All 17 PNEN cases under observation with a median 8-mm (range: 5–23) tumor size for a median of 34 (range: 2.4–114) months showed slight morphological change with a median tumor growth rate of 0.15 mm (range: 0–3.33) per year. CONCLUSION Patients with tumor measuring ≥ 2.0 cm in size have a high probability of lymph node metastasis or recurrence, thereby requiring resection. PNEN measuring < 1.0 cm in size may be acceptable for observation.