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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