Similar Outcomes in Minimally Invasive versus Open Management of Primary Pancreatic Neuroendocrine Tumors: A Regional, Multi-Institutional Collaborative Analysis

Abstract

In pancreatic neuroendocrine tumors (PNETs), the impact of minimally invasive (MI) versus open resection on outcomes remains poorly studied. We queried a multi-institutional pancreatic cancer registry for patients with resected non-metastatic PNET from 1996−2020. Recurrence-free (RFS), disease-specific survival (DSS), and operative complications were evaluated. Two hundred and eighty-two patients were identified. Operations were open in 139 (49%) and MI in 143 (51%). Pancreaticoduodenectomy was performed in 77 (27%, n = 23 MI), distal pancreatectomy in 184 (65%, n = 109 MI), enucleation in 13 (5%), and total pancreatectomy in eight (3%). Median follow-up was 50 months. Thirty-six recurrences and 13 deaths from recurrent disease yielded 5-year RFS and DSS of 85% and 95%, respectively. On multivariable analysis, grade 1 (HR 0.07, p < 0.001) and grade 2 (HR 0.20, p = 0.002) tumors were associated with improved RFS, while T3/T4 tumors were associated with worse RFS (OR 2.78, p = 0.04). MI resection was not associated with RFS (HR 0.53, p = 0.14). There was insufficient mortality to evaluate DSS with multivariable analysis. Of 159 patients with available NSQIP data, incisional surgical site infections (SSIs), organ space SSIs, Grade B/C pancreatic fistulas, reoperations, and need for percutaneous drainage did not differ by operative approach (all p > 0.2). Nodal harvest was similar for MI versus open distal pancreatectomies (p = 0.16) and pancreaticoduodenectomies (p = 0.28). Minimally invasive surgical management of PNETs is equivalent for oncologic and postoperative outcomes.

Keywords: minimally invasive surgery; oncologic outcomes; pancreatic neuroendocrine tumor; perioperative outcomes.

Figure 1

Temporal trends in attempted minimally invasive resections and proportion of attempted minimally invasive resections converted to open in patients with pancreatic neuroendocrine tumors. Trends in minimally invasive approach shown for (A) distal pancreatectomy and (B) pancreaticoduodenectomy. Data shown as 2-year bins starting in 2005, before which there were no laparoscopic resections attempted for either procedure.

Figure 2

Kaplan–Meier plot of recurrence-free (RFS) and disease-specific survival (DSS) in patients undergoing resection of pancreatic neuroendocrine tumors. (A,C) 5-year RFS was not significantly different by operative approach for patients undergoing pancreaticoduodenectomy (log rank p = 0.49) and distal pancreatectomy (log rank p = 0.29). (B,D) 5-year DSS was not significantly different by operative approach for patients undergoing pancreaticoduodenectomy (log rank p = 0.79) and distal pancreatectomy (log rank p = 0.92).

Figure 3

Kaplan–Meier plot of liver recurrence-free survival in patients undergoing resection of pancreatic neuroendocrine tumors, stratified by operative approach. Five-year liver-RFS 87% versus 95%, log-rank p = 0.03.