Pancreatic neuroendocrine tumors - from enucleation to liver transplantation

Introduction: Pancreatic neuroendocrine tumors (pNETs) belong to the gastroenteropancreatic neuroendocrine tumors family and they are uncommon, accounting about 5% of the pancreatic tumors. Improvements of investigation methods and the classification criteria is associated with an increased incidence, non-functioning tumors having a higher proportion compared to the functioning ones (insulinomas, gastrinomas, VIP-omas, glucagonomas). Materials and methods: This is a retrospective study including patients with pancreatic neuroendocrine tumors hospitalized in I-st and II-nd Clinics of Surgery during 2009-2015. Results: There were submitted 30 patients (mean age 49.07 years) with pancreatic neuroendocrine tumors, with diameter between 1 cm and 12 cm and of these 80% of patients were symptomatic (n=24). The functioning character was found in 56.6% of patients, insulinomas having the largest number (n=13), followed by gastrinomas (n=3). The therapeutic options were the enucleation of the tumor (n=15), segmental resection (Beger's procedure) (n=1) standard duodenopancreatectomy (n=8), distal pancreatectomy (n=4) and spleen-preserving near-total pancreatectomy (n=1) and a case of pancreatic biopsy, due to suspected liver metastases. Histopathologic examination confirmed the presence of malignant or highly suspected malignant tumors in 45% of patients. Postoperative complications was notice at 25% of patients, 3 patients developing pancreatitis with low flow fistula (10%), 3 patients had delayed gastric emptying syndrome, one patient required surgical reintervention for haemoperitoneum and 2 patients developing pseudocyst. Conclusions: Therapeutic alternatives for pancreatic neuroendocrine tumors are limited. Surgery is the most common therapeutic option and it is the only one with curative potential and liver transplantation may be indicated in highly selected patients to provide immediate relief of otherwise intractable pain or hormone-related symptoms or if metastases are limited to the liver.