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Background Knowledge of factors able to predict the clinical outcome of homogenous series of entero-pancreatic endocrine tumours treated with somatostatin analogues is poor. This study was aimed at identifying predictors for efficacy of somatostatin analogues at inhibiting tumour growth and modifying patients' survival during long-term follow-up. Patients and methods 31 patients with entero-pancreatic well-differentiated endocrine carcinoma received long-acting somatostatin analogues. All had progressive, metastatic disease (87% liver metastases, 38.7% distant extra-hepatic metastases). Results Response rate after 6 months of treatment was 45.2% (all disease stabilisation: 27.8% of pancreatic vs. 81.8% of intestinal tumours, P = 0.007). The predictors for non-response were: pancreatic tumour (OR 5.8), no previous surgery (OR 6.7), and the presence of distant extra-hepatic metastases, the latter being also confirmed by multivariate analysis (OR 10.0). Responders maintained stabilisation for 26.5 months, and none died during follow-up. Different survival curves were observed for patients, responding at 6 months compared to non-responders (P = 0.004), 3-year survival rate being 100% and 52.3%, respectively. Conclusions Distant extra-hepatic metastases are the major predictor of poor efficacy of somatostatin analogues in progressive, metastatic, well-differentiated entero-pancreatic endocrine carcinomas. Patients achieving response after 6 months of treatment, maintain it throughout a long-term follow-up. Non-responders after 6 months of treatment, have a worse survival, and should be considered for alternative treatments.

Background In patients with digestive endocrine tumours, complete pre-operative staging is essential in planning proper management and evaluating treatment efficacy. To date, somatostatin receptor scintigraphy (SRS) is considered the ‘gold standard’ imaging procedure, and very few data are available concerning the use of helical computed tomography (hCT). This study aimed to determine the diagnostic accuracy and the ability to modify the surgical management of hCT, alone or combined with SRS. Patients and methods Sixty patients were staged before surgery by hCT, SRS and tumour markers, and included in group 1 if suitable for radical surgery, otherwise in group 2. All patients underwent laparotomy followed by subsequent re-staging. Results SRS sensitivity was 77%, 48% and 67% for primary, lymph-node and liver lesions, respectively. hCT sensitivity was 94%, 69% and 94% for primary, lymph-node and liver lesions, respectively (P = 0.02 versus SRS, for liver lesions). During pre-operative evaluation, hCT correctly staged 92% and SRS 75% of patients (P = 0.02). hCT provided additional information in 17% of patients. Conclusions Since hCT has been shown to be extremely accurate, providing essential information for the planning of surgical treatment compared with that of SRS, both techniques should be used in the pre-operative work-up of digestive endocrine tumours.

Minimally invasive surgery has become a well-accepted modality in the management of neuroendocrine tumors (NETs). Laparoscopic approach is the treatment of choice for colorectal NET and it represents a crucial tool for establishing the localization of a lesion after noninvasive studies failed to identify the site of the neoplasm. On the other hand, there is no general consensus regarding the indications for and limitations of laparoscopic surgery for pancreatic NETs. Several studies demonstrated that laparoscopic distal pancreatic resection for NET is safe and feasible providing long-term results comparable with those achieved in open surgery. The main advantage of minimally invasive approach is to reduce the length of hospital stay and to lower significantly blood loss. Several experiences have also reported a significant decrease in the overall complication rate. Laparoscopic pancreaticoduodenectomy is not widely performed due to the associated technical difficulties. However, many studies have shown the effectiveness and safety of this procedure, when performed by expert laparoscopic surgeons. Robotic surgery can overcome the technical difficulties of traditional laparoscopic surgery by restoring three-dimensional vision, enhancing surgeon dexterity and eliminating tremor. Although the role of lymphadenectomy in pancreatic NET has not well established, a robot assisted distal pancreatic resection seems to be associated with a higher median number of resected lymph nodes. Nevertheless, a robotic approach is still limited to highly selected patients and there are many concerns regarding cost-effectiveness of these operations. Conclusions: Laparoscopic surgery is a valid option for NETs. This technique has been widely demonstrated to be safe and feasible with all the advantages of a minimally invasive approach in terms of pain, cosmetic results, length of stay and overall complications. These promising results have to be confirmed by future prospective randomized trials. Disclosure: All authors have declared no conflicts of interest.

Methods: Data from 19 Italian centers involved in the treatment of metastatic RCC were retrospectively collected. Kaplan-Meier and log-rank test methods were used to evaluate the overall survival (OS). Clinical variables considered were sex, age, concomitant metastasis to other sites, surgical resection of PM-RCC and time to PM-RCC occurrence. A subsequent univariate and backward multivariate Cox regression model was fitted to the data to correct for the effect of covariates. Results: 103 patients were enrolled in the analysis; 66 of them were males. Median age was 67 yrs (range 43–85 yrs). PM-RCC were synchronous in only 3 patients (3%). In 56 patients (54%), the pancreas was the only metastatic site, whereas in the other 47 patients lung (57%), lymph nodes (28%) and liver (21%) were the most common concomitant metastatic sites. Median time for PM-RCC occurrence was 9.6 yrs (range 0–24 yrs) after nephrectomy. Surgical resection of PM-RCC was performed in 40 patients (39%) and consisted of total (21%), distal (71%) or central pancreatectomy (8%). Median OS was not reached in patients who underwent surgical resection of PM-RCC and 11.1 yrs in the unresected patients (p Conclusions: The presence of PM-RCC is associated with long survival, which is surprisingly not associated with surgical resection, time of PM-RCC occurrence and the presence of concomitant metastases to other sites, although these data should be confirmed in a larger population. Disclosure: All authors have declared no conflicts of interest.