Surgical Diagnosis And Prognosis Of Nonfunctioning Pancreatic Neuroendocrine Neoplasms

Objective:By studying the characteristics,diagnosis and prognosis of nonfunctional pancreatic neuroendocrine Neoplasms(Nonfunctioning Pancreatic Neuroendocrine Neoplasms,NF-PNENs),we can improve the clinician's understanding and diagnosis and treatment of the disease,make clear the preoperative diagnosis as much as possible,formulate positive surgical treatment strategies for patients and improve the prognosis of patients.Methods:The clinical data of 41 patients with pancreatic neuroendocrine neoplasms admitted to the second affiliated hospital of Kunming Medical University from January 2009 to December 2018 were collected.The clinical and pathological data of the patients were analyzed retrospectively,including age,sex,tumor size,location,classification and staging,surgical procedure,postoperative complications,follow-up,etc.The factors that may affect the prognosis of the patients were analyzed by Kaplan-Meier method and single factor analysis,and the survival curve was drawn,and the difference test was carried out by Log-rank method.P<0.05 was statistically significant,the factors affecting the prognosis of patients were obtained,and the statistically significant factors were included in the Cox risk proportion model,and the multivariate analysis was carried out to obtain the independent risk factors affecting the prognosis.Results:This study included 41 NF-pNENs patients and obtained 40 follow-up cases,the success rate of follow-up was 97.56%,the follow-up time was 6?1 08 months.The 1 year survival rate was 97.5%and the 3 year survival rate was 87.2%.Among the 41 NF-pENs patients,23 underwent radical resection,12 underwent enucleation of pancreatic tumors,and 6 underwent palliative surgery(gastrointestinal anastomosis,biliary anastomosis,partial resection of pancreatic tumors).One patient died 6 months after operation,two patients had lymph node metastasis,lung metastasis,bone metastasis,36 months after operation,one patient died of other causes 60 months after operation,and the rest survived until the end of the follow-up date.Univariate analysis suggested that tumor differentiation,TNM stage,lymph node metastasis,and liver metastasis were the relevant factors affecting the prognosis of patients(P<0.05).the factors with significance in univariate analysis(P<0.05)were included in the Cox proportional risk model,it was concluded that the degree of tumor differentiation(P<0.05)was an independent risk factor.Conclusions:1.Tumor differentiation degree,TNM stage,lymph node metastasis,liver metastasis are the risk factors affecting the prognosis of NF-pNENs patients,among which tumor differentiation degree is an independent risk factor affecting the prognosis of NF-pNENs patients.2.The PET-CT(68Ga-PET-CT)of gallium-labeled somatostatin analogs showed high sensitivity and specificity,which was superior to abdominal CT?MRI?EUS.3.Obtaining the pathological examination results before operation to make a clear diagnosis,and grade the tumor,take the corresponding treatment,can obviously improve the prognosis of NF-pNENs patients.4.Surgery is the most effective means to treat the disease at present,patients undergoing radical surgery should undergo lymph node dissection.Patients undergoing pancreatic tumor enucleation should strictly grasp the indications and biopsy suspicious lymph nodes during the operation,once positive,radical surgery and regional lymph node dissection should be performed.