Long-Term Pancreatic Functional Impairment after Surgery for Neuroendocrine Neoplasms.

Andreasi Andreasi,Capurso Capurso,Falconi Falconi,Muffatti Muffatti,Partelli Partelli,Balzano Balzano,Crippa Crippa

doi:10.3390/jcm8101611

Abstract

Radical surgery represents the only curative treatment for pancreatic neuroendocrine neoplasms (PanNEN). The aim of this study was to evaluate the postoperative onset of diabetes mellitus (DM) and/or pancreatic exocrine insufficiency (PEI) in surgically treated PanNEN. Consecutive PanNEN patients, without preoperative DM, who underwent partial pancreatic resection, were included. After a median follow-up of 72 months, overall 68/276 patients (24%) developed DM. Patients who developed DM were significantly older (p = 0.002) and they had a higher body mass index (BMI) (p < 0.0001) than those who did not; they were more frequently male (p = 0.017) and with nonfunctioning neoplasms (p = 0.019). BMI > 25 Kg/m2 was the only independent predictor of DM (p = 0.001). Overall, 118/276 patients (43%) developed a PEI, which was significantly more frequent after pancreaticoduodenectomy (p < 0.0001) and in patients with T3-T4 tumors (p = 0.001). Pancreaticoduodenectomy was the only independent predictor of PEI (p < 0.0001). Overall, 54 patients (20%) developed disease progression. Patients with and without DM had similar progression free survival (PFS), whereas patients without PEI had better five-year-PFS (p = 0.002), although this association was not confirmed in multivariate analysis. The risk of DM and PEI after surgery for PanNEN is relatively high but it does not affect PFS. BMI and pancreatic head resection are independent predictors of DM and PEI, respectively.

Highlights

Pancreatic neuroendocrine neoplasms (PanNEN) represent less than 3% of all pancreatic lesions
It is of paramount importance to evaluate the long-term functional sequelae following pancreatic resection for PanNEN and to find a balance between the oncological risk and the impact of endocrine and exocrine impairment on general health status
Various studies have explored the functional outcomes after pancreatic resection in large populations, including patients affected by different pancreatic diseases, ranging from benign conditions to cancer [19,20,29,30,31]

Summary

Introduction

Pancreatic neuroendocrine neoplasms (PanNEN) represent less than 3% of all pancreatic lesions. The onset of diabetes mellitus (DM) and/or pancreatic exocrine insufficiency (PEI) might have a considerable impact on the general health status and on the quality of life of these patients [7,8] At this regard, it has been reported that malnutrition that results from PEI can lead to the development of comorbidities that negatively impact on prognosis [9,10]. It has been reported that malnutrition that results from PEI can lead to the development of comorbidities that negatively impact on prognosis [9,10] For these reasons, parenchyma-sparing surgical procedures (i.e., enucleation and middle pancreatectomy) have been proposed for reducing the incidence of postoperative pancreatic endocrine and exocrine insufficiency [11,12,13,14] and it has been widely reported that parenchyma-sparing surgery, enucleation in particular [15,16], is associated to improved long-term functional outcomes as compared to formal resections [11,16,17,18,19]. Several studies, investigating patients with different benign or low-grade malignant lesions, have shown that the type of surgical procedure (parenchyma-sparing vs. standard resection), and other patients’ related factors, such as age or the presence of chronic pancreatitis, might contribute to the post-surgical development of pancreatic insufficiency [19,20,21]

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Conclusion