Indications and outcomes of enucleation versus formal pancreatectomy for pancreatic neuroendocrine tumors |
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| Authors: | Charlotte M. Heidsma Diamantis I. Tsilimigras Susan van Dieren Flavio Rocha Daniel E. Abbott Ryan Fields Paula M. Smith George A. Poultsides Cliff Cho Mary Dillhoff Alexandra G. Lopez-Aguiar Zaheer Kanji Alexander Fisher Bradley A. Krasnick Kamran Idrees Eleftherios Makris Megan Beems Casper H.J. van Eijck Timothy M. Pawlik |
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| Affiliation: | 1. Department of Surgery, The Ohio State University, Wexner Medical Center, 410 W 10th Ave, OH 43210, Columbus, USA;2. Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands;3. Department of Surgery, Virginia Mason Medical Center, 1100 9th Ave, Seattle, WA, 98101, USA;4. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, 750 Highland Ave, WI, 53726, USA;5. Department of Surgery, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA;6. Division of Surgical Oncology, Department of Surgery, Vanderbilt University, 1211 Medical Center Drive, Nashville, TN, 37232, USA;7. Department of Surgery, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305-2200, USA;8. Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA;9. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, 1365 Clifton Rd, Atlanta, GA, 30322, USA;10. Department of Surgery, Erasmus Medical Center, Doctor Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands |
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| Abstract: | BackgroundPancreatoduodenectomy (PD) or distal pancreatectomy (DP) are common procedures for patients with a pancreatic neuroendocrine tumor (pNET). Nevertheless, certain patients may benefit from a pancreas-preserving resection such as enucleation (EN). The aim of this study was to define the indications and differences in long-term outcomes among patients undergoing EN and PD/DP.MethodsPatients undergoing resection of a pNET between 1992 and 2016 were identified. Indications and outcomes were evaluated, and propensity score matching (PSM) analysis was performed to compare long-term outcomes between patients who underwent EN versus PD/DP.ResultsAmong 1034 patients, 143 (13.8%) underwent EN, 304 (29.4%) PD, and 587 (56.8%) DP. Indications for EN were small size (1.5 cm, IQR:1.0–1.9), functional tumors (58.0%) that were mainly insulinomas (51.7%). After PSM (n = 109 per group), incidence of postoperative pancreatic fistula (POPF) grade B/C was higher after EN (24.5%) compared with PD/DP (14.0%) (p = 0.049). Median recurrence-free survival (RFS) was comparable among patients who underwent EN (47 months, 95% CI:23–71) versus PD/DP (37 months, 95% CI: 33–47, p = 0.480).ConclusionComparable long-term outcomes were noted among patients who underwent EN versus PD/DP for pNET. The incidence of clinically significant POPF was higher after EN. |
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