Surgical Outcomes after Synchronous versus Metachronous Hepatectomy in Patients with Metastatic Pancreatic Neuroendocrine Tumors

Abstract

Introduction: 40-80% of patients with pancreatic neuroendocrine tumors (pNETs) have liver metastases at diagnosis, and debulking surgery can improve survival. Limited data are available on the safety of pancreatectomy with synchronous hepatectomy (SH) for metastatic pNETs. Methods: Patients who underwent hepatectomy for metastatic pNETs at Mayo Clinic from 2000 to 2020 were retrospectively reviewed. Differences between groups were assesssed using chi-square and Mann-Whitney tests. Results: 185 patients underwent hepatectomy for metastatic pNETs: 131 SH and 54 metachronous hepatectomy (MH). SH patients were more likely to have >10 metastases (52.7% vs. 33.3%, p=0.025) and bilobar disease (81.7% vs. 66.7%, p=0.043). Major pancreatectomy (pancreaticoduodenectomy/total pancreatectomy) was performed in 7.6% of SH and 32.6% of MH patients (p<0.001) and major hepatectomy (>/=3 Couinaud segments) in 33.6% of SH and 38.9% of MH patients (p=0.605). >90% debulking was achieved in 93.1% of SH and 94.4% of MH (p=0.999). SH patients had longer operative times (median 289 minutes vs. 222, p<0.001) and greater blood loss (32.8% >1000 ml vs. 13.0%, p=0.010). Transfusion was required in 43.5% after SH and 29.6% after MH (p=0.112). Major complications (Clavien-Dindo >/=3) occurred in 29.8% after SH and 24.1% after MH (p=0.546). Median length of stay was 7 days after SH and 5 days after MH (p<0.001). 90-day mortality was 1.5% after SH and 1.9% after MH (p>0.999). Conclusion: Pancreatectomy with SH can be safely performed in selected patients with metastatic pNETs at high-volume institutions and should be considered in patients presenting with pNETs and synchronous liver metastases.