Outcome after laparoscopic enucleation for non-functional neuroendocrine pancreatic tumours

• Published in: HPB (Oxford, England) England), 2012-03, Vol.14 (3), p.171-176
• Main Authors: Fernández-Cruz, Laureano, Molina, Víctor, Vallejos, Rodrigo, Jiménez Chavarria, Enrique, López-Boado, Miguel-Angel, Ferrer, Joana
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Cell Differentiation; enucleation; Feasibility Studies; Gastroenterology and Hepatology; Humans; laparoscopic resection; laparoscopy; Laparoscopy - adverse effects; Liver Neoplasms - secondary; Lymph Node Excision; Lymphatic Metastasis; Middle Aged; Neuroendocrine Tumors - secondary; Neuroendocrine Tumors - surgery; non-functional neuroendocrine pancreatic tumours; Original; Pancreatectomy - adverse effects; Pancreatectomy - methods; pancreatic fistula; Pancreatic Fistula - etiology; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; regional lymphadenectomy; Spain; Time Factors; Treatment Outcome; Tumor Burden
• ISSN: 1365-182X; 1477-2574
• DOI: 10.1111/j.1477-2574.2011.00422.x

Abstract Background Non-functional endocrine pancreatic tumours (NPT) of more than 2 cm have an increased risk of malignancy. The aim of the present study was: (i) to define the guidelines for laparoscopic enucleation (LapEn) in patients with a non-functional NPT ≤3 cm in diameter; (ii) to evaluate pancreas-related complications; and (iii) to present the long-term outcome. Methods Between April 1998 and September 2010, 30 consecutive patients underwent laparoscopic surgery for a non-functional NPT (median age 56.5 years, range 44–83). Only 13 patients with tumours ≤3 cm in size underwent LapEn. Local lymph node dissection to exclude lymph node involvement was performed in all patients. Results The median tumour size, operative time and blood loss were 2.8 cm (range 2.8–3), 130 min (range 90–280) and 220 ml (range 120–300), respectively. A pancreatic fistula occurred in five patients: International Study Group of Pancreatic Fistula (ISGPF) A in two patients and ISGPF B in three patients. The median follow-up was 48 months (12–144). Three patients with well-differentiated carcinoma are free of disease 2, 3 and 4 years after LapEn and a regional lymphadenectomy. One patient, 5 years after a LapEn, presented with lymph node and liver metastases. Conclusions The present study confirms the technical feasibility and acceptable morbidity associated with LapEn. Intra-operative lymph node sampling and frozen-section examination should be performed at the time of LapEn; when a malignancy is confirmed, oncologically appropriate lymph node dissection should be performed.