Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2025
The morbidity of simultaneous pancreatic and liver resection for metastatic pancreatic neuroendocrine tumors.
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Kone Lyonell B, Wong Paul, Jacobs Michael J, Maker Ajay V
Аннотация
BACKGROUND: Between 40% and 80% of pancreatic neuroendocrine tumors (PNETs) present with liver metastases. Liver resection or debulking of metastatic PNET has been shown to improve long-term survival. However, limited data exist on the morbidity associated with simultaneous vs staged resection for PNETs, posing a challenge for clinical decision-making.
METHODS: Clinical variables were collected from the 2014-2020 American College of Surgeons National Surgical Quality Improvement Program databases for patients who underwent major and minor hepatectomy and pancreatectomy. Of note, 30-day morbidity and secondary perioperative outcomes were compared between the combined and isolated surgery cohorts using multivariate regression analysis (MVA) and propensity score matching (PSM).
RESULTS: Among more than 7000 patients with neuroendocrine tumors, 1917 underwent resection of neuroendocrine liver metastases. Of these patients, 1246 had isolated liver resections, 177 had isolated pancreatic resections, and 494 underwent simultaneous liver and pancreatic PNET resections. Both MVA and PSM revealed no significant differences in morbidity (49% vs 46%; P =.35) or other perioperative outcomes between simultaneous and isolated pancreatic resection. However, compared with isolated liver resection, simultaneous resection was associated with increased morbidity, longer operative time, higher blood transfusion requirements, and a greater incidence of infections. Importantly, obesity was an independent predictor of increased morbidity with simultaneous resection (56% vs 43%; P =.005), but not with isolated pancreatic (45% vs 47%; P =.84) or isolated hepatic (29% vs 29%; P =.94) resections.
CONCLUSION: The morbidity profile of simultaneous resection of neuroendocrine liver metastases and pancreatic primary tumors was comparable with that of isolated pancreatic resection. However, compared with isolated liver resection, simultaneous resection resulted in increased perioperative morbidity and a greater risk of infections, underscoring the importance of careful patient selection and perioperative management to optimize outcomes. Compared with isolated resection, the morbidity for simultaneous resection was significantly higher in patients with obesity.
METHODS: Clinical variables were collected from the 2014-2020 American College of Surgeons National Surgical Quality Improvement Program databases for patients who underwent major and minor hepatectomy and pancreatectomy. Of note, 30-day morbidity and secondary perioperative outcomes were compared between the combined and isolated surgery cohorts using multivariate regression analysis (MVA) and propensity score matching (PSM).
RESULTS: Among more than 7000 patients with neuroendocrine tumors, 1917 underwent resection of neuroendocrine liver metastases. Of these patients, 1246 had isolated liver resections, 177 had isolated pancreatic resections, and 494 underwent simultaneous liver and pancreatic PNET resections. Both MVA and PSM revealed no significant differences in morbidity (49% vs 46%; P =.35) or other perioperative outcomes between simultaneous and isolated pancreatic resection. However, compared with isolated liver resection, simultaneous resection was associated with increased morbidity, longer operative time, higher blood transfusion requirements, and a greater incidence of infections. Importantly, obesity was an independent predictor of increased morbidity with simultaneous resection (56% vs 43%; P =.005), but not with isolated pancreatic (45% vs 47%; P =.84) or isolated hepatic (29% vs 29%; P =.94) resections.
CONCLUSION: The morbidity profile of simultaneous resection of neuroendocrine liver metastases and pancreatic primary tumors was comparable with that of isolated pancreatic resection. However, compared with isolated liver resection, simultaneous resection resulted in increased perioperative morbidity and a greater risk of infections, underscoring the importance of careful patient selection and perioperative management to optimize outcomes. Compared with isolated resection, the morbidity for simultaneous resection was significantly higher in patients with obesity.