Preliminary Results of a Single Center Brazilian Cohort of Small Pnets Treated with Surgery or Active Surveillance

Surgery and active surveillance have been recommended as therapeutic options for small pancreatic neuroendocrine tumors (pNETS). Analyze safety and preliminary results of surgical resection and active surveillance for non-functional, non-metastatic pNETs with two centimeters or less in a Brazilian single center. A retrospective cohort study with review of medical charts from patients with pNETs with 2 cm or less admitted to our center from 2002 to 2020 was performed. Patients with multicentric, metastatic disease or poorly differentiated histology were excluded. A total of 64 patients were analysed, 41 in the surgical approach and 23 in the active surveillance group. Median age was 57 (46-62) and 61 (52-74) respectively (p =0.096).Tumor size was comparable in the two groups, median diameter 14 (10-170)mm vs 12(10-15)mm;p = 0.53. In contrast, tumors located in the head of the pancreas were more common in the surveillance than in the surgery group 41%vs 17% (p=0,038).In the surgical approach group, the perioperative morbidity rate was 29% and the most common surgical complication was abdominal infection with 22%.Median hospital stay was 8 days (3-23) and there was no mortality.The median follow-up period was 38.6 months in the surveillance group and 46.4 months in the surgical cohort.No patient developed disease progression or recurrence.One patient in the active surveillance group decided to undergo surgery after a 1 year follow-up period, by personal choice. Our findings suggest that both approaches are safe and acceptable for patients with pNETs < 2.0 cm.Long-term outcome and quality of life should be considered when discussing such options with patients.