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Medline ® Abstract for Reference 98

of 'Surgical resection of sporadic pancreatic neuroendocrine tumors'

Periampullary pancreatic somatostatinoma.
House MG, Yeo CJ, Schulick RD
Ann Surg Oncol. 2002;9(9):869.
BACKGROUND: Somatostatinomas involving the gastrointestinal tract are extremely rare neoplasms that typically present with indolent, nonspecific symptoms in the absence of systemic neuroendocrine manifestations that characterize the somatostatinoma syndrome. Because of a relatively large size at the time of presentation (average diameter of 5 cm) and common location within the head of the pancreas, the Whipple procedure (pancreaticoduodenectomy) serves as the predominant modality for curative and palliative surgical approaches.
METHODS: Two cases of somatostatinoma involving the minor duodenal papilla with concomitant pancreatic divisum were reviewed, with a general overview of this unique islet cell tumor.
RESULTS: Unlike typical somatostatinomas, these two tumors were subcentimeter in size but were associated with synchronous regional metastasis.
CONCLUSIONS: Somatostatinomas are often associated with regional and/or portal metastases at the time of diagnosis, and only 60% to 70% of surgical cases result in complete tumor resection. Predictors of an unfavorable prognosis includesize>3 cm, poor cytological differentiation, regional and/or portal metastasis, and incomplete surgical resection. Even in the presence of synchronous metastases, the 5-year overall survival for patients with somatostatinoma is approximately 40%. Currently, there are no clinical trials demonstrating significant improvement in survival with the use of adjuvant therapy.
Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.