Evolving Patterns in the Detection and Outcomes of Pancreatic Neuroendocrine Neoplasms

摘要: 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, changes presentation PNENs 2 time groups: 1977-1999 (77 patients) 2000-2005 (91 patients). Results Ninety-eight (58.3%) had nonfunctioning PNENs, 86 which were incidental. Insulinomas most common type functional neoplasm (33.3%), followed by gastrinomas glucagonomas; 12 (7.1%) multiple endocrine neoplasia 1. Of neoplasms, 107 (63.7%) located body or tail. A pancreaticoduodenectomy was performed 37 (22.0%), distal pancreatectomy done 88 (52.4%), rest either middle segment enucleation. There no operative deaths. classified 76.8% as benign; those malignant, 25.6% liver metastases. patients, 10.1% received adjuvant therapy. Complete follow up available 90.5% (mean, 63.3 months). Five- 10-year actuarial survival rates 77% 62%, respectively. Incidentally discovered significantly more frequent last 5 years (60.4% vs 40.3%;  = .007), with trend toward smaller 4.2 cm 5.6 cm;  = .19) lesser likelihood malignancy (21.8% 40.0%;  = .08). Conclusions report large single-center experience Increasing numbers are being resected, largely owing to incidental neoplasms. This may lead treatment less malignant