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. MaithelTimothy M. Pawlik

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
JournalHPB
DOIs
StateAccepted/In press - 2020

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