Pancreatic Endocrine Tumors With Major Vascular Abutment, Involvement, or Encasement and Indication for Resection

Abstract

Malignant pancreatic endocrine tumors (PETs) may have a good prognosis.^1-7 Unfortunately, a proportion present late with tumors that encase or invade adjacent major blood vessels.^8-10A number of studies have shown that vascular invasion in patients with both pancreatic adenocarcinomas and advanced PETs is associated with decreased survival.^2,4,11-15 The surgical approach to this group of patients is controversial. Based on analogies to pancreatic adenocarcinoma and limited experience with attempted surgical resection of patients with advanced PETs, for many, involvement of the superior mesenteric vein (SMV), inferior vena cava (IVC), portal vein (PV), splenic vein with extensive varices, superior mesenteric artery (SMA), aorta, or heart is considered a contraindication to surgery.^11,14,16