Surgical strategy for large or malignant endocrine pancreatic tumors

Endocrine pancreatic tumors (EPTs) are rare but have a remarkably better pr ognosis than adenocarcinoma of the pancreas. Patients with EPTs benefit fro m surgical and medical therapy, which may alleviate symptoms due to hormona l excess and increase survival. Patients with large or malignant EPTs with infiltrative disease may suffer from local complications, including gastroi ntestinal bleeding and obstruction and involvement of the superior mesenter ic (SMV) and portal (PV) veins. Among 31 patients with operable and large o r malignant EPTs, 7 had hormone-producing syndromes (insulin, glucagon), an d 24 had clinically nonfunctioning EPTs. Surgery in these patients included vascular reconstruction of the SMV/PV (n = 4), resection of infiltrated ad jacent organs (n = 5; stomach, transverse colon), or resection of concomita nt liver metastases (n = 3). Four patients with conspicuously large insulin omas, and three with glucagonoma were successfully operated on with allevia tion of hormonal symptoms. Among the 24 nonfunctioning EPTs, 5 patients had been explored earlier and their tumors judged inoperable due to locally in vasive disease or misdiagnosis as pancreatic adenocarcinoma. The operations were performed with no mortality and low morbidity. We conclude that large and malignant EPTs with limited spread of disease may benefit from a combi nation of medical and surgical therapy.