Pancreaticoduodenectomy (PD) has been performed infrequently for islet cell tumors of the pancreas due to the perceived perioperative morbidity and the protracted natural history of those tumors.
Researchers from Minnesota, USA, sought to determine whether the improved safety of PD affects long-term outcome of patients with islet cell tumors.
They assessed 29 consecutive patients (14 male, 15 female) who had undergone PD or total pancreatectomy for islet cell tumors, between 1980 and 1995. The mean age of the patients was 56 years and their mean tumor size was 4 cm.
The patients were followed by outpatient clinic visits and mail correspondence.
The researchers based their diagnoses were on histologic findings and endocrine (biochemical) manifestations of the tumors.
| Complication rate = 31%|
Operative mortality = 10%
|World Journal of Surgery|
In addition, clinical and pathologic factors were analyzed for prognostic risk.
Additionally, the team generated survival and recurrence curves using the Kaplan-Meier method, and a log-rank test was used for comparison.
The majority of tumors were found to be nonfunctioning (n = 20); there were 4 somatostatinomas, 3 insulinomas, and 2 gastrinomas.
The researchers discovered that the average operating time was 316 minutes and median transfusion requirement was 0 units.
They also found that standard Whipple resection was performed in 20 patients, the pylorus-preserving Whipple procedure in 7, and total pancreatectomy in 2.
Regional lymph nodes were involved by tumor in 16 patients.
The team identified the complication rate to be 31%, and operative mortality to be 10%.
However, overall survival was 81% and 70% at 5 and 10 years, while recurrence-free survival was 76% at 5 and 10 years.
They also identified a trend toward greater recurrence-free survival for node-negative patients (88% versus 65% at 5 years), while overall survival was also greater for node-negative patients (100% versus 67% at 5 years).
Dr Juan Sarmiento's team concluded that "PD is an appropriate strategy for selected malignant islet cell tumors of the pancreas, which offers extended survival with a low recurrence rate and control of endocrine symptoms".