Surgical experience with nonfunctioning neuroendocrine tumors of the pancreas

Nonfunctioning neuroendocrine tumors of the pancreas are rare slow-growing tumors with a more indolent natural history compared with pancreatic adenoc arcinoma. This retrospective report reviews the surgical experience with no nfunctioning neuroendocrine tumors in an academic referral center. Statisti cal analysis was performed using Student's t test and Kaplan-Meier method c ompared with log-rank tests. Thirty-eight patients (24 males and 14 females ) underwent surgery for a neuroendocrine tumor of the pancreas from 1984 th rough 1999. Twenty-eight patients with a mean age of 59.9 years had nonfunc tioning islet cell tumors and 10 patients with a mean age of 59.1 years had functioning islet cell tumors (four gastrinomas, three glucagonomas, two i nsulinomas, and one vipoma). The nonfunctioning islet cell tumors were loca ted in the head, neck, or uncinate process in 14 patients (50%), the body i n seven (25%), and the tail in seven (25%). Operative procedures for the no nfunctioning islet cell tumors included nine pancreaticoduodenectomies, 12 distal pancreatectomies, three palliative bypasses, and four exploratory la parotomies without a resection or bypass. Mean survival for the four patien ts explored and not resected or bypassed was 7 months. Median survival for node-negative patients was 124 months, for node-positive patients 75 months , and for patients with metastasis to the liver 9 months. Estimated 2-year actuarial survival for the node-negative patients was 77.8 per cent, for no de-positive patients 71.4 per cent, and for patients with metastasis to the liver 36.4 per cent. Six patients (60%) with node-negative disease, three (43%) with node-positive disease, and one (9%) with metastasis to the liver are alive at a mean follow-up of 41.8 months (range 1-167). Significant di fferences in median survival and 2-year survival were demonstrated between the node-pssitive/node-negative patients and those with metastasis to the l iver (P = 0.003). Patients with localized nonmetastatic disease should be c onsidered for pancreatic resection as estimated median survival is 75 month s or greater. Hepatic metastasis is a major predictor of survival.