Surgical Resection of Sporadic Pancreatic Neuroendocrine Tumors: A Two-Decade Experience at a Large Volume Cancer Center

Abstract

Introduction: Neuroendocrine tumors (NET) are indolent, although an estimated 50% of patients present with metastatic disease. Surgical resection may be reasonable in well-selected patients at every disease stage; but for patients with pancreatic NETs (PNETs), operative risk must be carefully balanced with the risk of progression or recurrence. The objective of this study was to determine post-pancreatectomy long-term outcomes in PNET patients undergoing resection. Methods: From 2000-2020, clinicopathologic information was collected for patients undergoing resection for sporadic PNETs (inherited PNETs excluded) at a large volume cancer center. Surgical complications were prospectively tracked (from 2011) using the Modified Accordion Grading System (MAGS; Major Complication:Grade≥3). Results: Among 392 resected PNET patients, 52.6% were male with a median age of 57 years (IQR:48-66). Twenty percent of patients presented with metastatic disease. Operations performed included enucleation (7.7%), distal pancreatectomy (56.9%), central pancreatectomy (4.3%), pancreaticoduodenectomy (30.1%), and total pancreatectomy (1.0%). Median tumor size was 3 cm (IQR:1.9-5.0), with an R0 resection rate of 90.8%. Twenty-nine percent of all patients had a major complication, (Table). Concurrent hepatic metastatectomy was performed in 12% of patients with a major complication rate of 7.1%. Median overall survival (OS) of all patients was 171 months. Nonmetastatic PNET patients had improved OS compared to metastatic patients (179 months vs.103 months, p<0.001, Figure). Conclusion: PNET resection is safe and can be associated with prolonged survival. Further, resection of the primary PNET and associated metastatic disease is not associated with increased morbidity in selected patients and may achieve long-term survival.Tabled 1Perioperative VariableNumber% / IQRLength of Stay (days, median)86-11Readmission3623.1Any Complication11875.6MAG≥34629.5Delayed Gastric Emptying2012.8Pancreatic Fistula7346.8Postoperative Transfusion127.7Pulmonary Embolism31.9Myocardial Infarction10.6 Open table in a new tab