Indications and outcomes of enucleation versus formal pancreatectomy for pancreatic neuroendocrine tumors

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; Elisabeth J M Nieveen van Dijkum; Shishir K Maithel; Timothy M Pawlik

doi:10.1016/j.hpb.2020.06.015

Indications and outcomes of enucleation versus formal pancreatectomy for pancreatic neuroendocrine tumors

HPB (Oxford). 2021 Mar;23(3):413-421. doi: 10.1016/j.hpb.2020.06.015. Epub 2020 Aug 6.

Authors

Charlotte M Heidsma¹, Diamantis I Tsilimigras², Susan van Dieren³, Flavio Rocha⁴, Daniel E Abbott⁵, Ryan Fields⁶, Paula M Smith⁷, George A Poultsides⁸, Cliff Cho⁹, Mary Dillhoff², Alexandra G Lopez-Aguiar¹⁰, Zaheer Kanji⁴, Alexander Fisher⁵, Bradley A Krasnick⁶, Kamran Idrees⁷, Eleftherios Makris⁸, Megan Beems⁹, Casper H J van Eijck¹¹, Elisabeth J M Nieveen van Dijkum³, Shishir K Maithel¹⁰, Timothy M Pawlik¹²

Affiliations

¹ Department of Surgery, The Ohio State University, Wexner Medical Center, 410 W 10th Ave, OH 43210, Columbus, USA; Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands.
² Department of Surgery, The Ohio State University, Wexner Medical Center, 410 W 10th Ave, OH 43210, Columbus, USA.
³ Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands.
⁴ Department of Surgery, Virginia Mason Medical Center, 1100 9th Ave, Seattle, WA, 98101, USA.
⁵ Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, 750 Highland Ave, WI, 53726, USA.
⁶ Department of Surgery, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA.
⁷ Division of Surgical Oncology, Department of Surgery, Vanderbilt University, 1211 Medical Center Drive, Nashville, TN, 37232, USA.
⁸ Department of Surgery, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305-2200, USA.
⁹ Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
¹⁰ Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, 1365 Clifton Rd, Atlanta, GA, 30322, USA.
¹¹ Department of Surgery, Erasmus Medical Center, Doctor Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands.
¹² Department of Surgery, The Ohio State University, Wexner Medical Center, 410 W 10th Ave, OH 43210, Columbus, USA. Electronic address: [email protected].

PMID: 32771338
DOI: 10.1016/j.hpb.2020.06.015

Abstract

Background: Pancreatoduodenectomy (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.

Methods: Patients 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.

Results: Among 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).

Conclusion: Comparable 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.

MeSH terms

Humans
Neuroendocrine Tumors* / surgery
Pancreatectomy / adverse effects
Pancreatic Fistula / epidemiology
Pancreatic Fistula / etiology
Pancreatic Neoplasms* / surgery
Pancreaticoduodenectomy / adverse effects
Postoperative Complications / etiology
Retrospective Studies
Treatment Outcome