Pancreatic Neuroendocrine Tumors in MEN1 Patients: Difference in Post-Operative Complications and Tumor Progression between Major and Minimal Pancreatic Surgeries

SIMPLE SUMMARY: We described post-operative complications, pancreatic sequelae, and post-surgical progression/relapse of pancreatic neuroendocrine neoplasms (PNENs) in 43 patients with multiple endocrine neoplasia type 1 (MEN1), who underwent major or minimal pancreatic surgeries. The performance of a more conservative intervention, compared to both pancreaticoduodenectomy (PD) and distal pancreatectomy (DP), was associated with the absence of post-surgical complications, but required further pancreas surgeries for tumor relapse in 40.0% of the operated cases. Our data showed that major pancreatic resections (PD and DP) were effective in both preventing tumoral progression and guaranteeing a long-term PNEN relapse-free survival time in most of N+ and/or M+ patients. ABSTRACT: Pancreatic neuroendocrine neoplasms (PNENs) affect over 80% of patients with multiple endocrine neoplasia type 1 (MEN1). Surgery is usually the therapy of choice, but the real immediate and long-term therapeutic benefit of a partial extensive pancreatic resection remains controversial. We analyzed, in 43 PNEN MEN1 patients who underwent 19 pancreaticoduodenectomies (PD), 19 distal pancreatectomies (DP), and 5 minimal pancreatectomies, the prevalence of surgery-derived early complications and post-operative pancreatic sequelae, and the PNEN relapse-free survival time after surgery, comparing major (PD+DP) and minimal pancreatic surgeries. No post-operative mortality was observed. Metastatic cancers were found in 12 cases, prevalently from duodenal gastrinoma. Long-term cure of endocrine syndromes, by the 38 major pancreatic resections, was obtained in 78.9% of gastrinomas and 92.9% of insulinomas. In only one patient, hepatic metastases, due to gastrinoma, progressed to death. Out of the 38 major surgeries, only one patient was reoperated for the growth of a new PNEN in the remnant pancreas. No functioning PNEN persistence was reported in the five minimal pancreatic surgeries, PNEN relapse occurred in 60% of patients, and 40% of cases needed further pancreatic resection for tumor recurrence. No significant difference in PNEN relapse-free survival time after surgery was found between major and minimal pancreatic surgeries.