Notice: Users may be experiencing issues with displaying some pages on stanfordhealthcare.org. We are working closely with our technical teams to resolve the issue as quickly as possible. Thank you for your patience.
 

Learn about the flu shot, COVID-19 vaccine, and our masking policy »

Stanford Health Care

Indications and outcomes of enucleation versus formal pancreatectomy for pancreatic neuroendocrine tumors. HPB : the official journal of the International Hepato Pancreato Biliary Association Heidsma, C. M., Tsilimigras, D. I., van Dieren, S., Rocha, F., Abbott, D. E., Fields, R., Smith, P. M., Poultsides, G. A., Cho, C., Dillhoff, M., Lopez-Aguiar, A. G., Kanji, Z., Fisher, A., Krasnick, B. A., Idrees, K., Makris, E., Beems, M., van Eijck, C. H., Nieveen van Dijkum, E. J., Maithel, S. K., Pawlik, T. M. 2020

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 (1.5cm, 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.

View details for DOI 10.1016/j.hpb.2020.06.015

View details for PubMedID 32771338