Cytoreductive surgery in advanced endocrine tumours of the pancreas

Surgery still plays an important role evert in advanced endocrine tumours o f the pancreas, owing to their biological behaviour. Sometimes it is possib le to attempt a radical approach, but more often only cytoreduction is feas ible. lit fact, when the malignancy is not completely resectable on account of vessel involvement or extensive liver metastases, surgical reduction of the tumour burden (debulking) can be proposed, aimed at improving the clin ical conditions and survival of these patients. Forty-one patients sufferin g from advanced endocrine tumour of the pancreas were observed from 1985 to 1996 in 13 patients, the disease was locally advanced as far as concerns l ymph node metastases and/or vessel involvement, while the other 28 patients presented liver metastases. In the former group, we performed 6 radical re sections, in the latter we submitted 2 patients to radical resection and 22 patients to cytoreductive surgery, with complete removal of the pancreatic malignancy. The overall survival of the resected patients was 87% (7/8). T hree patients (37.5%) are alive and free of disease, while the other 4 have subsequently developed liver metastases. One patient died with hepatic rec urrence. Half the patients (6/12) undergoing cytoreductive surgery are aliv e, 3 with stable and 3 with progressive disease. The other 6 patients have died due to liver progression of the disease. As data in the literature con cerning the role of debulking as regards the survival are conflicting, we h ave modified our surgical approach in patients with advanced disease. We pe rform cytoreductive surgery whenever complete removal of the pancreatic tum our is feasible. The rationale of this approach is to leave only a liver wi th residual disease, with a view to giving targeted adjuvant treatment.