Minimally Invasive Versus Open Pancreatectomy for Right-Sided and Left-Sided G1/G2 Nonfunctioning Pancreatic Neuroendocrine Tumors: A Multicenter Matched Analysis with an Inverse Probability of Treatment-Weighting Method.

Abstract

BACKGROUND:

Limited evidence exists for the safety and oncologic efficacy of minimally invasive surgery (MIS) for nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs) according to tumor location. This study aimed to compare the surgical outcomes of MIS and open surgery (OS) for right- or left-sided NF-PNETs.

METHODS:

The study collected data on patients who underwent surgical resection (pancreatoduodenectomy, distal/total/central pancreatectomy, duodenum-preserving pancreas head resection, or enucleation) of a localized NF-PNET between January 2000 and July 2017 at 14 institutions. The inverse probability of treatment-weighting method with propensity scores was used for analysis.

RESULTS:

The study enrolled 859 patients: 478 OS and 381 MIS patients. A matched analysis by tumor location showed no differences in resection margin, intraoperative blood loss, or complications between MIS and OS. However, MIS was associated with a longer operation time for right-sided tumors (393.3 vs 316.7 min; P < 0.001) and a shorter postoperative hospital stay for left-sided tumors (8.9 vs 12.9 days; P < 0.01). The MIS group was associated with significantly higher survival rates than the OS group for right- and left-sided tumors, but survival did not differ for the patients divided by tumor grade and location. Multivariable analysis showed that MIS did not affect survival for any tumor location.

CONCLUSION:

The short-term outcomes offered by MIS were comparable with those of OS except for a longer operation time for right-sided NF-PNETs. The oncologic outcomes were not compromised by MIS regardless of tumor location or grade. These findings suggest that MIS can be performed safely for selected patients with localized NF-PNETs.

• Authors: Ho Kyoung Hwang, Ki Byung Song, Minsu Park, Wooil Kwon, Jin-Young Jang, Jin Seok Heo, Dong Wook Choi, Chang Moo Kang, Joon Seong Park, Tae Ho Hong, Chol Kyoon Cho, Keun Soo Ahn, Huisong Lee, Seung Eun Lee, Chi-Young Jeong, Young Hoon Roh, Hee Joon Kim, Dae Wook Hwang, Song Cheol Kim, Ho-Seong Han, Yoo-Seok Yoon, Korean Pancreas Surgery Club
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 28 Issue 12 Pg. 7742-7758 (Nov 2021) ISSN: 1534-4681 [Electronic] United States
• PMID: 33969463 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © 2021. Society of Surgical Oncology.

Topics

• Humans
• Minimally Invasive Surgical Procedures
• Neuroendocrine Tumors (surgery)
• Pancreatectomy
• Pancreatic Neoplasms (surgery)
• Pancreaticoduodenectomy
• Propensity Score
• Retrospective Studies
• Treatment Outcome