Postoperative Complications, In-Hospital Mortality and 5-Year Survival After Surgical Resection for Patients with a Pancreatic Neuroendocrine Tumor: A Systematic Review

Abstract

Studies on postoperative complications and survival in patients with pancreatic neuroendocrine tumors (pNET) are sparse and randomized controlled trials are not available. We reviewed all studies on postoperative complications and survival after resection of pNET. A systematic search was performed in the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE from 2000-2013. Inclusion criteria were studies of resected pNET, which described postoperative complications separately for each surgical procedure and/or 5-year survival after resection. Prospective and retrospective studies were pooled separately and overall pooled if heterogeneity was below 75%. The random-effect model was used. Overall, 2643 studies were identified and after full-text analysis 62 studies were included. Pancreatic fistula (PF) rate of the prospective studies after tumor enucleation was 45%; PF-rates after distal pancreatectomy, pancreatoduodenectomy, or central pancreatectomy were, respectively, 14-14-58%. Delayed gastric emptying rates were, respectively, 5-5-18-16%. Postoperative hemorrhage rates were, respectively, 6-1-7-4%. In-hospital mortality rates were, respectively, 3-4-6-4%. The 5-year overall survival (OS) and disease-specific survival (DSS) of resected pNET without synchronous resected liver metastases were, respectively, 85-93%. Heterogeneity between included studies on 5-year OS in patients with synchronous resected liver metastases was too high to pool all studies. The 5-year DSS in patients with liver metastases was 80%. Morbidity after pancreatic resection for pNET was mainly caused by PF. Liver resection in patients with liver metastases seems to have a positive effect on DSS. To reduce heterogeneity, ISGPS criteria and uniform patient groups should be used in the analysis of postoperative outcome and survival.

Fig. 1

Flow Chart of the search strategy

Fig. 2

Overall pancreatic fistula rate after tumor enucleation

Fig. 3

Overall pancreatic fistula rate after distal pancreatectomy

Fig. 4

Overall pancreatic fistula rate after pancreatoduodenectomy

Fig. 5

Overall delayed gastric emptying rate after tumor enucleation

Fig. 6

Overall delayed gastric emptying rate after distal pancreatectomy

Fig. 7

Overall delayed gastric emptying rate after pancreatoduodenectomy

Fig. 8

Overall postoperative hemorrhage rate after tumor enucleation

Fig. 9

Overall postoperative hemorrhage rate after distal pancreatectomy

Fig. 10

Overall postoperative hemorrhage rate after pancreatoduodenectomy

Fig. 11

Overall 5-year survival in patients without liver metastases. ¹ High grade: patients with grade 3 or poorly differentiated pNET may be included. ² MEN: patients with a hereditary syndrome such as MEN1 syndrome or von Hippel Lindau may be included. ³ NF/F. Patients with non-functional pNET or functional pNET may be included. + Some patients are affected with the condition. − None of the patients are affected with the condition. NS not specified. The study did not specified the number of patients with the condition

Fig. 12

Overall 5-year survival in patients with liver metastases. ¹ High grade: patients with grade 3 or poorly differentiated pNET may be included. ² MEN: patients with a hereditary syndrome such as MEN1 syndrome or von Hippel Lindau may be included. ³ NF/F. Patients with non-functional pNET or functional pNET may be included. + Some patients are affected with the condition. − None of the patients are affected with the condition. NS not specified. The study did not specified the number of patients with the condition

Fig. 13

Pancreatic fistula rate grade B/C after tumor enucleation

Fig. 14

Pancreatic fistula rate grade B/C after distal pancreatectomy

Fig. 15

Overall pancreatic fistula rate after central pancreatectomy

Fig. 16

Pancreatic fistula rate grade B/C after central pancreatectomy

Fig. 17

Overall delayed gastric emptying rate after central pancreatectomy

Fig. 18

Overall postoperative hemorrhage rate after central pancreatectomy

Fig. 19

In-hospital mortality rate after tumor enucleation

Fig. 20

In-hospital mortality rate after distal pancreatectomy

Fig. 21

In-hospital mortality rate after pancreatoduodenectomy

Fig. 22

In-hospital mortality rate after central pancreatectomy

Fig. 23

5-year disease-specific survival in patients without liver metastases. ¹ High grade: patients with grade 3 or poorly differentiated pNET may be included. ² MEN: patients with a hereditary syndrome such as MEN1 syndrome or von Hippel Lindau may be included. ³ NF/F. Patients with non-functional pNET or functional pNET may be included. + Some patients are affected with the condition. − None of the patients are affected with the condition. NS not specified. The study did not specified the number of patients with the condition

Fig. 24

5-year disease-specific survival in patients with liver metastases. ¹ High grade: patients with grade 3 or poorly differentiated pNET may be included. ² MEN: patients with a hereditary syndrome such as MEN1 syndrome or von Hippel Lindau may be included. ³ NF/F. Patients with non-functional pNET or functional pNET may be included. + Some patients are affected with the condition. − None of the patients are affected with the condition. NS not specified. The study did not specified the number of patients with the condition