Possibilities of Surgical Treatment of Neuroendocrine Neoplasia of the Pancreatic Head, Invading the Main Veins

The aim of the study was to show the possibility and relative safety of resection of the portal and/or superior mesenteric vein invaded by a tumor during surgical treatment of neuroendocrine neoplasia of the pancreatic head, as well as the possibility of simultaneous liver resection for resectable metastases in patients with stage IV disease during primary surgery and with the progression of the disease at any stage after surgical treatment. Materials and methods: surgical treatment of 16 patients with neuroendocrine neoplasia of the pancreatic head with invasion of the superior mesenteric and/or portal vein of stages III-IV of high and moderate degree of differentiation (G1 and G2) included standard gastropancreoduodenal resection in 87.5% of cases, extended gastropancreoduodenal resection with aortocoval lymphodissection in 6.25% and pancreatectomy – 6.25%. Results: The rate of surgical treatment in the volume of R0 was 93.8%, the rate of complications of surgical intervention of class III and above on the Clavien-Dindo scale was 43.8%, with a total rate of all complications of 75%. The main complications were gastrostasis (50.1%), erosive bleeding (18.8%), bleeding from acute gastrointestinal ulcers (18.8%), and pneumonia (18.8%). The frequency of postoperative portal and/or superior mesenteric vein thrombosis was 12.5%, pancreatodigestive anastomosis was 12.5%, biliodigestive anastomosis was 6.3%, and pancreatic fistula was 12.5%. With a median follow-up period of 62.6 months, disease progression was detected in 62.5% of patients, the median time to progression was 39.7 months, and mortality from progression was 50%. Local recurrence developed in 12.5% of patients, retroperitoneal lymph node metastases – in 6.25%, liver metastases – in 43.75%, in two cases liver resection was performed for metastases. The median overall survival was 70.1 months, the median survival without signs of disease progression was 49.2 months, 1-year survival rates were 81.2% and 78.6%, respectively, 3–year-olds were 68.2% and 63.5%, 5–year-olds were 68.2% and 36.3%, 10–year-olds were 20.55% and 18.1%. Conclusion: the results of surgical treatment of patients with neuroendocrine neoplasia of the pancreatic head with invasion of the portal and/or superior mesenteric vein indicate the acceptability, relative safety and effectiveness of resections of these major veins.