Small pancreatic and periampullary neuroendocrine tumors: Resect or enucleate?

Objective - The aim of this study was to compare the outcomes of enucleation versus resection in patients with small pancreatic, ampullary, and duodenal neuroendocrine tumors (NETs). Methods - Multi-institutional retrospective review identified all patients with pancreatic and peri-pancreatic NETs who underwent surgery from January 1990 to October 2008. Patients with tumors ≤3 cm and without nodal or metastatic disease were included. Results - Of the 271 patients identified, 122 (45%) met the inclusion criteria and had either an enucleation (n=37) and/or a resection (n=87). Enucleated tumors were more likely to be in the pancreatic head (P=0.003) or functioning (P<0.0001) and, when applicable, less likely to result in splenectomy (P=0.0003). The rate of pancreatic fistula formation was higher after enucleation (P<0.01), but the fistula severity tended to be worse following resection (P=0.07). The enucleation and resection patients had similar operative times, blood loss, overall morbidity, mortality, hospital stay, and 5-year survival. However, for pancreatic head tumors, enucleation resulted in decreased blood loss, operative time, and length of stay compared to pancreaticoduodenectomy (P<0.05). Conclusion - These data suggest that most outcomes of enucleation and resection for small pancreatic and peri-pancreatic NETs are comparable. However, enucleation has better outcomes than pancreaticoduodenectomy for head lesions and the advantage of preserving splenic function for tail lesions.