- Surgical management of pancreatic neuroendocrine tumors
C.H.J. van Eijck
E.J.M. Nieveen van Dijkum
- Award date
- 2 October 2015
- Number of pages
- Document type
- PhD thesis
- Faculty of Medicine (AMC-UvA)
This thesis gives an overview of the surgical management and prognosis of patients with pancreatic neuroendocrine tumors (pNET).
A systematic review including 2600 studies, was performed on complications and survival after different surgical procedures for pNETs. The overall pancreatic fistula rate after enucleation was high (45%) compared to standard resections. The 5-year survival of resected pNETs without resected liver metastases was 85%.
In our own patient data, we analyzed the diagnostic value of chromogranin A and a Octreoscan. In patients with small tumors without suspicious metastases on CT scan, an additional Octreoscan is not mandatory. Chromogranin A was elevated in only 27% of patients preoperatively.
Further analysis revealed that the overall complication rate and the need for re-interventions/readmissions was not lower for enucleation compared to other resections. In addition, investigating 832 patients with different types of pancreatic pathology, a pNET was not a risk factor for the development of pancreatic fistula.
Interestingly, in our operated patients, the incidence of lymph node metastasis after pancreatoduodenectomy was high, even for small tumors.
Risk factors for recurrent disease after curative resection were identified: tumor size >2cm, positive lymph nodes and perineural invasion. Based on these risk factors we developed a nomogram to predict tumor recurrence in order to identify patients, which could benefit from adjuvant treatment and to adjust follow-up programs.
In a nationwide study on the outcome after laparoscopic or open distal pancreatectomy, we found laparoscopic distal pancreatectomy to be safe, especially after structured surgical training.
- Research conducted at: Universiteit van Amsterdam
Thesis (complete) (Embargo until 02 October 2017)
Chapter 7: The additional value of somatostatin receptor scintigraphy during preoperative staging in patients with non-functioning pancreatic neuroendocrine tumors. A clinical guidance (Embargo until 02 October 2017)
Chapter 9: Nomogram to predict recurrent disease in non-functional pancreatic neuroendocrine tumors. Identify the high risk patient (Embargo until 02 October 2017)
If you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library, or send a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible.