Minimally Invasive versus Open Distal Pancreatectomy for Pancreatic Neuroendocrine Tumors: An Analysis from the U.S. Neuroendocrine Tumor Study Group

Abstract

Introduction: The short- and long-term outcome of minimally invasive versus open surgery for treatment of pancreatic neuroendocrine tumor (pNET) remains undetermined. The objective of the current study was to compare short- and long-term oncologic outcomes after minimally invasive distal pancreatectomy (MIDP) with open distal pancreatectomy (ODP) for treatment of pNET. Method: Patients who underwent curative MIDP or ODP for pNET between 2000 and 2016 were identified from the US Neuroendocrine Tumor Study Group. Propensity score matching (PSM) was used to generate 1:1 matched MIDP and ODP patients. Data on postoperative morbidity, recurrence, and overall survival (OS) were compared between MIDP and ODP groups. Result: A total of 576 patients undergoing curative DP for pNET were included. 214 (37.2%) patients underwent MIDP, whereas 362 (62.8%) underwent ODP. MIDP was increasingly performed over time (2000-2004: 9.3% vs. 2013-2016: 54.8%; p<0.01). ODP was more likely to be performed among patients with advanced disease compared with MIDP. In the matched cohort (n=141 in each group), patients who underwent MIDP had less blood loss (median, MIDP 100 vs. ODP 200 ml, p<0.001), lower incidence of Clavein-Dindo ≥ III complications (MIDP 12.1% vs. ODP 24.8%, p=0.026), and a shorter hospital stay versus ODP (median, 4 versus 7 days, p=0.026). Patients who underwent MIDP had a lower incidence of recurrence (5-year cumulative recurrence, MIDP 10.1% vs. ODP 31.1%, p<0.001), yet equivalent OS (5-year OS, MIDP 92.1% vs. ODP 90.9%, p=0.550) compared with patients who underwent OPD. Conclusion: Patients undergoing MIDP over ODP in treatment of pNET had comparable oncologic surgical metrics, as well as similar long-term OS. A minimally invasive approach to pNET tumors should be considered when technically feasible.