Evolving patterns in the detection and outcomes of pancreatic neuroendocrine neoplasms: The Massachusetts General Hospital experience from 1977 to 2005

Parsia A. Vagefi, Oswaldo Razo, Vikram Deshpande, Deborah J. McGrath, Gregory Y. Lauwers, Sarah P. Thayer, Andrew L. Warshaw, Carlos Fernández-Del Castillo

Research output: Contribution to journalArticle

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Abstract

Objective: To assess changing patterns in the detection and outcomes of pancreatic neuroendocrine neoplasms (PNENs). Design: Retrospective review from May 21, 1977, through September 16, 2005. Setting: Massachusetts General Hospital, a tertiary care center. Patients: We evaluated 168 patients (51% male; mean age, 56 years) who underwent surgery for histologically confirmed PNENs. Main Outcome Measures: Surgical outcomes, survival, and changes in presentation of PNENs in 2 time groups: 1977-1999 (77 patients) and 2000-2005 (91 patients). Results: Ninety-eight patients (58.3%) had nonfunctioning PNENs, 86 of which were incidental. Insulinomas were the most common type of functional neoplasm (33.3%), followed by gastrinomas and glucagonomas; 12 patients (7.1%) had multiple endocrine neoplasia type 1. Of the neoplasms, 107 (63.7%) were located in the pancreatic body or tail. A pancreaticoduodenectomy was performed in 37 patients (22.0%), distal pancreatectomy was done in 88 (52.4%), and the rest had either middle segment pancreatectomy or enucleation. There were no operative deaths. We classified 76.8% of neoplasms as benign; of those classified as malignant, 25.6% had liver metastases. Of the patients, 10.1% received adjuvant therapy. Complete follow up was available in 90.5% of patients (mean, 63.3 months). Five- and 10-year actuarial survival rates were 77% and 62%, respectively. Incidentally discovered nonfunctioning neoplasms were significantly more frequent in the last 5 years (60.4% vs 40.3%; P=.007), with a trend toward smaller neoplasms (mean, 4.2 cm vs 5.6 cm; P=.19) and lesser likelihood of malignancy (21.8% vs 40.0%; P=.08). Conclusions: We report a large single-center experience with PNENs. Increasing numbers of PNENs are being resected, largely owing to the incidental detection of non-functioning neoplasms. This may lead to the treatment of smaller and less malignant neoplasms.

Original languageEnglish (US)
Pages (from-to)347-353
Number of pages7
JournalArchives of Surgery
Volume142
Issue number4
DOIs
StatePublished - Apr 1 2007
Externally publishedYes

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Pancreatic Neoplasms
General Hospitals
Neoplasms
Pancreatectomy
Glucagonoma
Gastrinoma
Multiple Endocrine Neoplasia Type 1
Insulinoma
Pancreaticoduodenectomy
Tertiary Care Centers
Survival Rate
Outcome Assessment (Health Care)
Neoplasm Metastasis
Survival
Liver
Therapeutics

ASJC Scopus subject areas

  • Surgery

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Evolving patterns in the detection and outcomes of pancreatic neuroendocrine neoplasms : The Massachusetts General Hospital experience from 1977 to 2005. / Vagefi, Parsia A.; Razo, Oswaldo; Deshpande, Vikram; McGrath, Deborah J.; Lauwers, Gregory Y.; Thayer, Sarah P.; Warshaw, Andrew L.; Fernández-Del Castillo, Carlos.

In: Archives of Surgery, Vol. 142, No. 4, 01.04.2007, p. 347-353.

Research output: Contribution to journalArticle

Vagefi, Parsia A. ; Razo, Oswaldo ; Deshpande, Vikram ; McGrath, Deborah J. ; Lauwers, Gregory Y. ; Thayer, Sarah P. ; Warshaw, Andrew L. ; Fernández-Del Castillo, Carlos. / Evolving patterns in the detection and outcomes of pancreatic neuroendocrine neoplasms : The Massachusetts General Hospital experience from 1977 to 2005. In: Archives of Surgery. 2007 ; Vol. 142, No. 4. pp. 347-353.
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abstract = "Objective: To assess changing patterns in the detection and outcomes of pancreatic neuroendocrine neoplasms (PNENs). Design: Retrospective review from May 21, 1977, through September 16, 2005. Setting: Massachusetts General Hospital, a tertiary care center. Patients: We evaluated 168 patients (51{\%} male; mean age, 56 years) who underwent surgery for histologically confirmed PNENs. Main Outcome Measures: Surgical outcomes, survival, and changes in presentation of PNENs in 2 time groups: 1977-1999 (77 patients) and 2000-2005 (91 patients). Results: Ninety-eight patients (58.3{\%}) had nonfunctioning PNENs, 86 of which were incidental. Insulinomas were the most common type of functional neoplasm (33.3{\%}), followed by gastrinomas and glucagonomas; 12 patients (7.1{\%}) had multiple endocrine neoplasia type 1. Of the neoplasms, 107 (63.7{\%}) were located in the pancreatic body or tail. A pancreaticoduodenectomy was performed in 37 patients (22.0{\%}), distal pancreatectomy was done in 88 (52.4{\%}), and the rest had either middle segment pancreatectomy or enucleation. There were no operative deaths. We classified 76.8{\%} of neoplasms as benign; of those classified as malignant, 25.6{\%} had liver metastases. Of the patients, 10.1{\%} received adjuvant therapy. Complete follow up was available in 90.5{\%} of patients (mean, 63.3 months). Five- and 10-year actuarial survival rates were 77{\%} and 62{\%}, respectively. Incidentally discovered nonfunctioning neoplasms were significantly more frequent in the last 5 years (60.4{\%} vs 40.3{\%}; P=.007), with a trend toward smaller neoplasms (mean, 4.2 cm vs 5.6 cm; P=.19) and lesser likelihood of malignancy (21.8{\%} vs 40.0{\%}; P=.08). Conclusions: We report a large single-center experience with PNENs. Increasing numbers of PNENs are being resected, largely owing to the incidental detection of non-functioning neoplasms. This may lead to the treatment of smaller and less malignant neoplasms.",
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