Long-term Outcomes of Surgical Treatment for Pancreatic Neuroendocrine Neoplasm With Synchronous Hepatic Metastasis: A Multicenter Retrospective Cohort Study.

OBJECTIVE

To evaluate surgical impact on the overall survival (OS) of pancreatic neuroendocrine neoplasm (pNEN) with synchronous hepatic metastases (sHMs).

METHODS

A total of 163 pNEN-sHM patients were recruited from 3 institutions in China, who were categorized into 3 groups: no resection, resection of the primary lesion, and resection of both primary and hepatic lesions (PHR). Cox regression was employed to evaluate surgical impact on the OS.

RESULTS

In the overall cohort analysis, PHR demonstrated a significant protective effect on OS (hazard ratio, 0.302; 95% confidence interval, 0.127-0.721; P = 0.007). Nevertheless, subgroup analysis revealed PHR conferred a survival advantage in patients with pancreatic neuroendocrine tumor (pNET) located on the pancreatic body/tail (bt-pNET-sHM) (hazard ratio, 0.287; 95% CI, 0.087-0.946; P = 0.040), whereas surgical treatment did not significantly impact survival in the subgroups of pancreatic neuroendocrine carcinoma-sHM or pancreatic head/neck pNET-sHM (hn-pNET-sHM).

CONCLUSIONS

In this study, the survival benefit of surgery was observed only in the bt-pNET-sHM subgroup. Considering the multifactorial nature of decision-making, surgical intervention for pNEN-sHM management should be approached with a careful and comprehensive assessment, to prevent excessive surgery strategies.