PANCREATICODUODENECTOMY FOR SELECTED PERIAMPULLARY NEUROENDOCRINE TUMORS - 50 PATIENTS

Background. Most resectable pancreatic or peripancreatic neuroendocrin e tumors are treated by enucleation or distal pancreatectomy. A minori ty of tumors may require pancreaticoduodenectomy for complete tumor ex cision because of their large size, location, or lymph node involvemen t. Methods. This study reviews the management of 50 patients treated b y pancreaticoduodenectomy for periampullary neuroendocrine tumors betw een 1962 and 1996 a single institution. Results. There were 30 men and 20 women with a mean age of 52 +/- 2 years. Functional tumors were re sected in 17 patients: insulinoma, seven tumors; gastrinoma, eight tum ors; vipoma, one tumor; and glucagonoma, one tumor. Tumors were classi fied as malignant in 29 patients and benign in 21. The median intraope rative blood loss was 800 ml, and the median number of units of blood transfused was zero. The postoperative length of stay was 20 +/- 2 day s. Postoperative morbidity included 11 patients (24 %) with a pancreat ic fistula and four patients (8%) with a biliary fistula. There was on e in-hospital death (2 %), in 1967. The actuarial survival rates at 2, 5, and 7 years are 81 %, 73 %, and 65 %, respectively. Patients with benign tumors had a significantly improved 5-year survival rate (94 %) compared with those with malignant tumors (61 % p = 0.03). Conclusion s. Selected patients with periampullary neuroendocrine tumors can be m anaged successfully by pancreaticoduodenectomy, with low mortality and acceptable morbidity rates.