gms | German Medical Science

Aim: We reviewed our institutional experience over the last 30 years after surgical therapy for malignant pancreatic endocrine tumors (mPET). Of special interest was the influence of lymph node status on the long term survival after curative R0 resection.

Material and Methods: A total of 52 patients (median age: 54 [17-79] years, 25 men, 27 women) with mPET was treated between 1978-2004. The data were collected prospectively. Survival was calculated by the Kaplan-Meier method and potential prognostic factors for survival were analysed using log-rank test.

Results: The primary tumor was located in the head of the pancreas in 24 patients (48%), in the pancreatic body in 7 patients (14%) and in the pancreatic cauda in 5 patients (30%). Four patients presented with a multicentric primary tumor of the pancreas.

The overall 5-year survival was 45,8% (±7,4%) (n=23/52). 41 patients were resected and had a 5-year survival of 50,8% (±8,3). Thirty two of them underwent R0 resection. These patients showed a 5 year survival of 57,9% (±9,3). None of the five patients who were R1 resected was alive after 5 years, but 2 of 4 patients were still alive after 5 years despite of R2 resection.

Regional lymph node status was documented in 30 patients with mPET after curative R0 resection. Lymph nodes were free of metastases in 17 cases (57%) and metastatically involved in 13 cases (43%). After 5 years, 59,5% (±12,9%) of the patients with tumor-free lymph nodes were alive vs. 60,6% (±13,8) of patients with positive lymph nodes (p = 0,95).

Discussion: Curative R0 resection in patients with malignant pancreatic endocrine tumors yields the best results in terms of long term survival. Following R0 resection of mPET, involvement of regional lymph nodes does not influence prognosis, so that the patients still have a chance for long term survival.