Diagnosis And Surgical Management Of Pancreatic Neuroendocrine Neoplasms: 92 Cases Report And Literature Review

Objective:To analyze the incidence characteristics, clinical presentation, tumor biology, diagnosis and treatment of pancreatic neuroendocrine neoplasms, and to promote the development of pNENs diagnosis and treatment techniques.Methods:The medical records of 92 consecutive patients with pNENs treated from January 2003 to December 2014 were reviewed retrospectively. The related literatures were discussed.Results:(1) 32 males and 60 females were included in this study.The ratio of male to female was 1:1.86, with a mean age of 45.86 (range 18～77)years. In the 92 patients with pNETs,71 of them (77.2%) were functional tumors, which were all diagnosed as the insulinoma. While the other 21 (22.8%) were nonfunctional tumors.(2) In the qualitative diagnosis of insulinoma, the sensitivity of blood glucose, serum insulin, IGI/G were 95.8%,66.7%,95.8%, respectively. In the localization diagnosis of pNENs, the sensitivity of abdominal ultrasound compared with CT, MRI, EUS was significant difference (P=0.001, P<0.001, P<0.001).(3) According to the WHO classification, NET accounted for 95.5%, NEC 4.5%, of which G1, G2, G3 accounted for 68.2%,27.3%,4.5%, respectively.66 cases made pathological immunohistochemical staining of Syn, the positive rate was 100%, and 63 cases made CgA staining, the positive rate was 95.2%.(4) 92 patients were all treated with operation.Pancreatic tumor enucleations were most commonly used operative approaches, which account for about 67.4%. Pancreatic fistula is the most common postoperative complication, the incidence rate was 39.1%, in which A, B, C accounted for 36.1%,58.3%,5.6%, respectively.(5) 76 patients were followed up, and follow-up rate was 82.6%. The follow-up time ranged 3 months to 243 months. The survival rates of 1 year,3 years and 5 years were100%,97.1%,95.7% respectively.Conclusions:(1) Pancreatic neuroendocrine tumors are a rare group of tumors with increasing incidence andprevalence. pNENs are a heterogeneous group of tumors with varying clinicalpresentation, tumor biology and prognosis. Clinicians must be aware of the variety of manifestations of thisdisease.(2) Abdominal ultrasound, CT, MRI, EUS is commonly used in clinical preoperative localization diagnosis. MRI, EUS are most sensitive, followed by CT, and abdominal B ultrasoundis the lowest. As CT has a higher sensitivity and more economical advantages, so it was always used as a preferred examination method. Intraoperative ultrasound in intraoperative positioning small tumor has some advantages. Immunohistochemical staining of Syn, CgA has high sensitivity and specificity in the pathological diagnosis.(3) Surgery is the preferred and most effective treatment for resectable PNETs, and may range from minimally invasive enucleation techniques to aggressive debulking strategies depending on the different situation of patients and disease.