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Endocrine

E178: Post-operative outcomes after pancreatectomy for neuroendocrine tumors

Introduction: There is a significant gap in the literature surrounding post-operative outcomes following resection of pancreatic neuroendocrine tumors (pNETs). Despite the differences in prognosis, and survival compared to pancreatic ductal adenocarcinoma (PDAC), the surgical approach remains largely analogous. This study aims to assess the incidence of post-operative complications and outcomes after pancreatectomy for pNET in comparison to PDAC.

Methods: This is a retrospective cohort study of patients who underwent pancreatectomy for pNET or PDAC between 2004 and 2022 at a single institution. The primary outcomes were post-operative complications which included: ileus, delayed gastric emptying, post-operative pancreatic fistula (POPF), bleeding, abscess, respiratory distress, neurological complication, sepsis, wound infection, urinary tract infection, pneumonia, percutaneous drain placement, and reoperation. Secondary outcomes included 30- and 90-day readmissions and death. In order to account for selection bias of the two cohorts, we used inverse probability treatment weighting (IPTW), based on propensity scores, to adjust for key confounders. IPTW was applied before performing a series of adjusted logistic regressions, stratified by resection type.

Results: A total of 971 patients underwent pancreatectomy; of those, 762 patients had PDAC while 209 patients had pNET. Resection types included pancreaticoduodenectomy (PD, 694 patients), distal pancreatectomy (DP, 270 patients). Median age was 67.0 years (IQR 59.0 – 74.0) and the cohort was 52.5% female (Table 1). For primary outcomes, within the PD cohort, the odds of POPF were 4.22 times higher in those with pNETs compared to those with PDAC (p< 0.001, 95% CI: 1.93 – 9.28). Otherwise, there were no significant differences in rates of complications between PDAC and pNET patients within the PD cohort and within the DP cohort. For secondary outcomes, within the DP cohort, there were lower odds of 90-day readmissions for the pNET group compared with the PDAC group (OR 0.36, 95% CI: 0.15 – 0.87, p=0.023). 

Conclusions: We found significantly higher rates of POPF after pancreaticoduodenectomy in patients with pNET compared to PDAC. We hypothesize that this may be due to softer glands and non-dilated pancreatic ducts in pNETs. These data can inform perioperative management and patient counseling.

Learning Objectives:

  • Upon completion, participant will be able to understand the gaps in literature as it relates to pancreatic neuroendocrine tumors.
  • Upon completion, participant will be able to list common post-operative complications after pancreatectomy.
  • Upon completion, participant will be able to describe differences in post-operative outcomes between patients with pNET versus PDAC.