TY - JOUR
T1 - Indications and outcomes of enucleation versus formal pancreatectomy for pancreatic neuroendocrine tumors
AU - Heidsma, Charlotte M.
AU - Tsilimigras, Diamantis I.
AU - van Dieren, Susan
AU - Rocha, Flavio
AU - Abbott, Daniel E.
AU - Fields, Ryan
AU - Smith, Paula M.
AU - Poultsides, George A.
AU - Cho, Cliff
AU - Dillhoff, Mary
AU - Lopez-Aguiar, Alexandra G.
AU - Kanji, Zaheer
AU - Fisher, Alexander
AU - Krasnick, Bradley A.
AU - Idrees, Kamran
AU - Makris, Eleftherios
AU - Beems, Megan
AU - van Eijck, Casper H. J.
AU - Nieveen van Dijkum, Elisabeth J. M.
AU - Maithel, Shishir K.
AU - Pawlik, Timothy M.
N1 - Publisher Copyright: © 2020 International Hepato-Pancreato-Biliary Association Inc.
PY - 2021/3
Y1 - 2021/3
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85089151470&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.hpb.2020.06.015
DO - https://doi.org/10.1016/j.hpb.2020.06.015
M3 - Article
C2 - 32771338
SN - 1365-182X
VL - 23
SP - 413
EP - 421
JO - HPB: The official journal of the International Hepato Pancreato Biliary Association
JF - HPB: The official journal of the International Hepato Pancreato Biliary Association
IS - 3
ER -