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Surgical therapy of neuroendocrine tumours of the pancreas

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Author(s): Tadeusz Popiela | Janusz Legutko | Piotr Szybiński

Journal: Polish Gastroenterology
ISSN 1232-9886

Volume: 15;
Issue: 1;
Start page: 9;
Date: 2008;
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Keywords: GEP NETs | insulinoma | glucagonoma | gastrinoma | VIPoma

ABSTRACT
Aim of study: The aim of this study was to report our own findings on diagnosing and treating pancreatic GEP NET in a single centre where ProfessorJan Glatzel carried out the first enucleation of insulinoma in Poland in 1939. Material and methods: The subject of this report were 55 patients with hormonally active pancreatic GEP NET, including 33 lesions producing insulin, 14 producing gastrin and 7 producing glucagon. One female patient was diagnosed with the Verner-Morrison syndrome typical fortumours producing VIP (vasoactive intestinal polypeptide). Each of these tumours demonstrates a separate clinical picture and causes different therapeutic problems. Results: Out of 55 patients with pancreatic GEP NET, 33 were operated with the preoperative diagnosis of insulinoma. lntraoperatively, the lesions were identified and resected in 29 patients, including one case of a bifocal tumour. No tumour could be found in 4 patients, and histopathological examination of surgical specimens revealed nesidioblastosis or beta-cell hyperplasia. Complete healing was achieved in all patients in whom tumours were resected and no relapse was observed overa 20-year observation period. However, relapse of hypoglycaemia requiring conservative therapy was observed in 4 patients with nesidioblastosis at different time intervals after surgery, related to the extent of pancreatic resection. Eleven of 14 patients with gastrinoma were operated. Two patients were treated conservatively with H2-receptor blockers and then proton pump inhibitors. One patient transferred from another department died due to massive gastrointestinal (Gl) haemorrhage caused by multiple gastric ulcers, and the final diagnosis was established at necropsy. Seven patients were qualified forsurgery due to the suspicion of pancreatic cancer. In this group, immunohistochemical tests of the surgical specimen revealed tumours producing glucagon (glucagonoma) and two of them were reported as neuroendocrine cancers. Surgical therapy of GEP NET has evolved similarly to other disciplines of surgery. However, it seems that the principal requirementin such cases is the precise visualisation of the tumour before surgery. The female patient suspected preoperatively for VIPoma under went an explorative laparotomy only, because the tumour could not be located even using intraoperative scintigraphy. The patient was treated conservatively and diarrhoea was controlled with long-acting somatostatin. Conclusions: Current works are also focused on other methods of systemie therapy for patients with GEP NET, and probably combined modality therapy will be of greater importance in the future.
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