Minimally invasive vs open pancreatectomy for nonfunctioning pancreatic neuroendocrine tumors

Abstract

Background: The mainstay of treating nonfunctioning-pancreatic neuroendocrine tumors(NF-PNETs) is surgical resection. However, minimally invasive approaches to pancreatic resection for treating NF-PNETs are not widely accepted, and the long-term oncological outcomes of such approaches remain unknown.

Aim: To determine the short- and long-term outcomes of minimally invasive pancreatic resection conducted in patients with NF-PNETs.

Methods: Prospective databases from Severance Hospital were searched for 110 patients who underwent curative resection for NF-PNETs between January 2003 and August 2018.

Results: The proportion of minimally invasive surgery (MIS) procedures performed for NF-PNET increased to more than 75% after 2013. There was no significant difference in post-operative complications (P = 0.654), including pancreatic fistula (P = 0.890) and delayed gastric emptying (P = 0.652), between MIS and open approaches. No statistically significant difference was found in disease-free survival between the open approach group and the MIS group (median follow-up period, 28.1 mo; P = 0.428). In addition, the surgical approach (MIS vs open) was not found to be an independent prognostic factor in treating NF-PNET patients [Exp(β) = 1.062; P = 0.929].

Conclusion: Regardless of the type of surgery, a minimally invasive approach can be safe and feasible for select NF-PNET patients.

Keywords: Laparoscopic distal pancreatectomy; Laparoscopic pancreaticoduodenectomy; Minimally invasive surgery; Nonfunctioning-pancreas neuroendocrine tumor; Oncologic outcome; Pancreatic neuroendocrine tumor.

Figure 1

Changes in surgical approaches for treating nonfunctioning-pancreatic neuroendocrine tumors over time. MIS: Minimally invasive surgery.

Figure 2

Comparison of disease-free survival rates between open pancreatic resection and minimally invasive approaches for treating patients with nonfunctioning pancreatic neuroendocrine tumors. DFS: Disease-free survival; MIS: Minimally invasive surgery; NF-PNET: Nonfunctioning-pancreatic neuroendocrine tumors.