Pancreatic neuroendocrine neoplasm: experience of individual laparoscopic pancreatectomy / 中华内分泌外科杂志

Objective To study the feasibility and safety of individual laparoscopic pancreatectomy for patients with pancreatic neuroendocrine neoplasm(pNEN).Methods 16 patients with pNEN admitted from Jan.2007 to Nov.2016 undergoing individual laparoscopic pancreatectomy were retrospectively analyzed.Results The operations were successfully accomplished in all the 16 patients,including 2 cases of local excision,2 cases of bundling method excision,2 cases of central pancreatectomy and pancreaticojejunostomy,4 cases of spleen-preserving distal pancreatectomy and 6 cases of distal pancreatectomy combined with splenectomy.The operation time was ranging from 60 to 260 mins,and the blood loss was from 50 to 300 ml.Three cases suffered from level A postoperative pancreatic leakage.The cases of grade G1,G2,G3 were 10,5,1,respectively.The follow-up period was from 3 to 121 months.One case of grade G2 died 46 months postoperatively and 1 case of grade G3 died 36 months postoperatively.Conclusion Individual laparoscopic pancreatectomy is safe and feasible for early pNEN.

Clinical observation of capecitabine and temozolomide in the treatment of advanced pancreatic neuroendocrine tumors / 中国肿瘤临床

Objective:To observe the therapeutic effect and toxicity of capecitabine and temozolomide in the treatment of advanced pancreatic neuroendocrine tumors. Methods:A total of 14 patients with stageⅣwell-differentiated pancreatic neuroendocrine tumor (NET G1/G2/G3) were treated with oral CAPTEM regimen, and the response rate, PFS and adverse effect after treatment were analyzed. All data analyses were performed using software SPSS17.0. Results:These 14 patients were followed-up for more than 2 years. Till Oct 2016, one patient got CR, one patient got PR, four patients got SD. Median progression-free survival was 8.9 months. The two year survival rate was 85.7%. Only one patient experienced grade 3 adverse events. Conclusion:CAPTEM is an effective and well-tolerated salvage regimen for the treatment of advanced well-differentiated pNET.

Preliminary study on digital image analysis of endoscopic ultrasonography in the differential diagnosis of benign and malignant pancreatic neuroendocrine neoplasm / 中华消化杂志

Objective To investigate the value of digital image analysis (DIA) of endoscopic ultrasonography (EUS) in the differential diagnosis of benign and malignant pancreatic neuroendocrine neoplasm (PNEN).Methods The relation between various parameters of EUS-imaging and benign and malignant lesions in 47 patients clinically diagnosed PNEN were retrospectively analyzed.Photoshop CS5 software was performed for digital image processing,and lesions related parameters were collected,including area,perimeter,length,circularity,gray,gray ratio,and gray standard deviation.The statistical method of t test was performed for comparison between two groups.Receiver operating characteristic (ROC) curve was analyzed in length,circularity,average gray scale ratio and gray standard deviation.Results Among the 47 patients,35 cases and 12 cases were in benign group and malignant group,respectively.The mean gray scale ratio and the circularity of benign group were significantly higher than those of malignant group (0.80±0,05 vs 0.74±0.07,0.63±0.17 vs 0.40±0.09),and the differences were statistically significant (t=2.659 and 5.787,both P＜0.05).The gray standard deviation of benign group were lower than that of malignant group (9.90 ± 1.24 vs 12.55± 3.27),and the difference was statistically significant (t=-2.733,P=0.018).The area under the curve (AUC) of circularity was 0.724 (95％ confidence interval(CI):0.546 to 0.901),the cut-off value was 0.767,the sensitivity and specificity were 71.43 ％ and 66.67％,respectively.The AUC of average gray ratio was 0.888 (95％CI:0.785 to 0.991),the cut-off value was 0.412,the sensitivity and specificity were 94.29％ and 75.00％,respectively.The AUC of gray standard deviation was 0.811 (95％CI:0.647 to 0.974),the cut-off value was 11.02,the sensitivity and specificity were 66.67％ and 85.71％,respectively.When combined with the three parameters of circularity,average gray scale ratio and gray standard deviation,the sensitivity and specificity were 97.14％ and 83.33％,and the accuracy was 93.61％.Conclusions EUS with DIA technology can improve the detection of EUS images to PNEN,and which may be complementary to EUS guided fine needle aspiration.It also privided a noninvasive,objective,convenient,and effective option for the differential diagnosis of benign and malignant PNEN.

Treatment of pancreatic neuroendocrine carcinoma liver metastasis / 中华肝胆外科杂志

Neuroendocrine carcinoma of the pancreas is uncommon in clinic,which has a low malignancy,maintains indolent patterns of growth,and has a good long-term prognosis.However,because of its atypical clinical manifestation,its delayed presentation often results in distant metastasis,in which the liver is the most common site.Currently,the treatment of pancreatic neuroendocrine liver metastasis is limited and requires a diverse and multidisciplinary combination of therapy.This manuscript will discuss the current status of treating pancreatic neuroendocrine carcinoma liver metastasis.

Clinical Usefulness of Plasma Chromogranin A in Pancreatic Neuroendocrine Neoplasm

Chromogranin A (CgA) is widely used as an immunohistochemical marker of neuroendocrine neoplasms and has been measurable in plasma of patients. We assessed the clinical role of plasma CgA in diagnosing pancreatic neuroendocrine neoplasm (PNEN). CgA was checked in 44 patients with pancreatic mass who underwent surgical resection from 2009 through 2011. The cutoff value for diagnosing PNEN and the relationships between CgA and clinicopathologic variables were analyzed. Twenty-six patients were PNENs and 18 patients were other pancreatic disorders. ROC analysis showed a cutoff of 60.7 ng/mL with 77% sensitivity and 56% specificity, and the area under the curve (AUC) was 0.679. Among PNEN group, the sensitivity and specificity of diagnosing metastasis were 100% and 90% respectively when CgA cutoff was 156.5 ng/mL. The AUC was 0.958. High Ki-67 index (160.8 vs 62.1 ng/mL, P = 0.001) and mitotic count (173.5 vs 74.6 ng/mL, P = 0.044) were significantly correlated with plasma CgA, but the tumor size was not. In conclusion, CgA has a little value in diagnosing PNEN. However, the high level of CgA (more than 156.5 ng/mL) can predict the metastasis. Also, plasma CgA level correlates with Ki-67 index and mitotic count which represents prognosis of PNENs.

Pancreatectomía central: relato de casos y descripción de la técnica / Central pancreatectomy: cases report and technique description

The conventional techniques of pancreatic resections, most of the time imply in the withdrawal of ex-tensive segments of pancreatic parenchyma, having as possible complications at the long time, the appearance of endocrine or exocrine insufficience. The central pancreatectomy consists in an alternative of pancreatic resection to resect benign or low grade malignant tumours located in the pancreatic isthmus. We present the clinical characteristics, image, and the surgical technique used, for withdraw of pancreatic isthmus nonfunctioning pancreatic neuroendocrine neoplasm and pancreatic serous cystic adenoma.

Las técnicas convencionales de resección pancreática para el tratamiento de enfermedades neoplásicas, en la mayoría de las veces implican la extirpación de segmentos extensos del parénquima pancreático, existiendo como eventuales complicaciones a largo plazo, el surgimiento de insuficiencia pancreática endocrina o exocrina. La pancreatectomía central se constituye en una alternativa de resección pancreática, que limita esta resección solamente al sector comprometido, especialmente en las neoplasias benignas o de bajo grado de malignidad. Presentamos las características clínicas, de imagen y la técnica empleada en dos pacientes, para el tratamiento quirúrgico de un tumor endocrino no funcionante y de un cistoadenoma seroso, localizados en el cuello del páncreas, mediante la pancreatectomía central.