Tratamentul chirurgical al tumorilor neuroendocrine ale pancreasului: experienţa unei instituţii singulare

Abstract

Introducere: Tumorile neuroendocrine ale pancreasului (TNEP) ocupă de la 1 la 2% din patologia pancreatică oncologică, incidenţa diagnosticării pe parcursul vieţii este de 12-15 cazuri la 1 milion de populaţie. Scop: Familiarizarea cu cea mai mare experienţă de tratament chirurgical al tumorilor neuroendocrine pancreatice din Ucraina. Material și metode: În Institutul Naţional de Chirurgie şi Transplantologie din ianuarie 2004 pînă în decembrie 2014 au fost trataţi 173 pacienţi cu TNEP, la care s-au efectuat 181 intervenţii chirurgicale. Tumori pancreatice neuroendocrine nonfuncţionale au fost diagnosticate la 103 pacienţi (59,5%), hormonal active – la 70 (40,5%). În cazul TNEP non-funcţionale predominau procedeele chirurgicale rezecţionale (operaţia Whipple, pancreatectomia stîngă), pentru majoritatea tumorilor hormonal active s-au utilizat interventii organomenajante (enucleerea tumorii). Rezultate: Complicaţii postoperatorii s-au dezvoltat la 18,4% pacienţi cu TNEP, cea mai frecventă fiind fistula pancreatică externă (9,8%). Mortalitatea postoperatorie a constituit 1,2%. Supraviețuirea generală la 5 ani a fost de 82,3%, TNE G1 – 100%, TNE G2 – 84,3%, carcinom neuroendocrin, CNE G3 – 38,7%.Concluzii: Nivelul complicaţiilor postoperatorii şi a indicatorilor mortalităţii corespunde celorlalte tumori ale pancreasului. Nivelul supravieţuirii de 5 ani este destul de mare, ceea ce sugerează utilizarea intervenţiilor organomenajante laparoscopice pentru formele localizate de TNEP. Formele avansate de TNEP nu reprezintă o contraindicaţie pentru tratamentul chirurgical, dar astfel de cazuri trebuie evaluate în mod individual. Incidenţa relativ mică a TNEP, complexitatea şi importanţa diagnosticului preoperator pentru alegerea strategiei curative optimale, justifică efectuarea tratamentului acestor pacienţi în centre specializate.

Introduction: Neuroendocrine tumors of the pancreas (PNET) range from 1 to 2% of pancreatic oncological pathology; the frequency during lifetime diagnostics is 12-15 cases per 1 million of population. Aim: Introduce the largest experience of surgical treatment of neuroendocrine tumors of the pancreas in Ukraine. Material and methods: In the National Institute of Surgery and Transplantology from January 2004 to December 2014 were treated 173 patients with neuroendocrine tumors of the pancreas, to whom were performed 181 surgeries. Non-functioning PNET were diagnosed in 103 patients (59.5%), hormone-active were in 70 (40.5%). In non-functioning PNET dominated resection surgeries (Whipple procedure, left-side pancreatectomy), at hormone-active were performed mostly organ-preserving surgeries (enucleation of tumor). Results: Postoperative complications occurred in 18.4% of patients with PNET, the most common complication was external pancreatic fistula (9.8%). Total postoperative mortality was 1.2%. The overall 5-year survival was 82.3%, NET G1 – 100%, NET G2 – 84.3%, neuroendocrine carcinoma, NEC G3 – 38.7%. Conclusions: The level of postoperative complications and mortality indicators complies with all tumors of the pancreas. The level of the overall 5-year survival is quite high, allowing for organ-preserving and laparoscopic surgeries for localized forms of PNET. Advance forms of PNET are not a contraindication to surgical treatment, but such cases must be evaluated individually. Relatively few of occurrences of PNET, the complexity and importance of preoperative diagnostic to choose the optimal treatments strategy, justifying perform the treatment of these patients in specialized centers.