Refractory Gastroesophageal Variceal Bleeding Secondary to Neuroendocrine Carcinoma in the Pancreatic Tail

Therapeutic Strategies for Advanced Pancreatic Neuroendocrine Tumors with Segmental Portal Hypertension

“…Most of the patients ( n = 34, 81 %) received systemic chemotherapy using mainly 5‐fluorouracil ( n = 31), streptozotocin ( n = 21), doxorubicin ( n = 21), cisplatinum ( n = 7), etoposide ( n = 7), and oxaliplatine ( n = 3). The median number of chemotherapy cycle in first line was four [1–19]. Regarding the radiological signs of SPH, no modification was observed.…”

“…Inversely, Solorzano et al reported that only 9 % of patients experienced complications related to the primary tumor in place [4]. In more general SPH literature, series suggest that most patients with SPH do not bleed [6, 25, 26] and for most authors, surgery is justified only for symptomatic patients [6, 11, 25, 27]. Our results confirm these results and palliative primary tumor resection could be proposed only in the rare case of frequent and severe hemorrhage.…”

“…SPH increase the bleeding during the operative procedure [5], and compromise any resection for many surgeons. Several authors have reported case report of PNETs with SPH [7][8][9][10][11] but current management of these patients has never been studied and no consensus guideline is available about segmental HTP management in PNET [12].…”

Pancreatic neuroendocrine tumor with splenic vein tumor thrombus: A case report

“…The risk of having gastric varices and upper gastrointestinal bleed is increased in patients with sinistral hypertension; thus, increasing both morbidity and mortality of PNETs. 10,11 The low incidence of PNETs and even lower incidence of associated splenic vein tumor thrombus, limits the possibility of prospective randomized trials to define differences in surgical treatment outcomes. In a comparison of patients with pancreatic adenocarcinoma who underwent distal pancreatectomy and splenectomy, Dedania and colleagues found that those who had a splenic vein thrombus were more likely to have pancreas-specific complications including pancreatic fistulas and delayed gastric emptying; the median survival, however, was not significantly different compared to patients who did not have a splenic vein thrombus.…”

“… 17 Other reported cases of a PNET invading into the splenic vein also document the patient presenting with sinistral hypertension, gastric varices and gastrointestinal bleeding. 10,11 …”