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Outcomes after distal pancreatectomy for neuroendocrine neoplasms: a retrospective comparison between minimally invasive and open approach using propensity score weighting

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Abstract

Background

Pancreatic neuroendocrine neoplasms (PanNEN) are ideal entities for minimally invasive surgery. The advantage of the laparoscopic approach in terms of complications, length of stay (LOS) and cosmetic results has been previously demonstrated. However, scarce data are available on long-term oncological outcomes. Aim of this study was to compare short-term postoperative outcomes, pathological findings and long-term oncological results of minimally invasive distal pancreatectomy (MIDP) and open distal pancreatectomy (ODP) for PanNEN.

Methods

Patients who underwent ODP or MIDP for nonfunctioning PanNEN (NF-PanNEN) were retrospectively analyzed. Inverse probability of treatment weighting using propensity score was performed to compare the outcomes of MIDP and ODP.

Results

Overall, 124 patients were included in the study: 84 underwent OPD, whereas 40 were submitted to MIDP. The rate of high-grade postoperative complications was significantly lower in the MIDP group (p = 0.005, grade of complication with highest estimated probability 0 vs 2) and the postoperative LOS was significantly shorter after MIDP (p < 0.001, estimated days 8 versus 10). The number of examined lymph nodes (ELN) in the ODP group was significantly higher (p = 0.0036, estimated number of ELN 13 vs 10). Similar disease-free survival and overall survival were reported for the two groups (p = 0.234 and p = 0.666, respectively).

Conclusions

Although MIDP for PanNEN seems to be associated with a lower number of ELN, long-term survival is not influenced by the type of surgical approach. MIDP is advantageous in terms of postoperative complications and LOS, but prospective studies are needed to confirm the overall oncological quality of resection in this group of neoplasms.

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Acknowledgements

Dr Valentina Andreasi PhD studentship and Dr Francesca Muffatti research fellowship were supported by Ms Gioja Bianca Costanza legacy donation. Authors thank the ERN EURACAN initiative.

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Authors and Affiliations

  1. Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, ENETS Center of Excellence, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Stefano Partelli, Valentina Andreasi, Eduardo Perez-Sanchez, Francesca Muffatti, Gianpaolo Balzano, Stefano Crippa, Clelia Di Serio & Massimo Falconi

  2. Vita-Salute San Raffaele University, Milan, Italy

    Stefano Partelli, Valentina Andreasi, Paola Maria Vittoria Rancoita, Francesca Muffatti, Stefano Crippa, Clelia Di Serio & Massimo Falconi

  3. University Centre for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy

    Paola Maria Vittoria Rancoita

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  1. Stefano Partelli
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  2. Valentina Andreasi
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Correspondence to Massimo Falconi.

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Drs. Stefano Partelli, Valentina Andreasi, Paola Maria Vittoria Rancoita, Eduardo Perez-Sanchez, Francesca Muffatti, Gianpaolo Balzano, Stefano Crippa, Clelia Di Serio, and Massimo Falconi have no conflicts of interest or financial ties to disclose.

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Partelli, S., Andreasi, V., Rancoita, P.M.V. et al. Outcomes after distal pancreatectomy for neuroendocrine neoplasms: a retrospective comparison between minimally invasive and open approach using propensity score weighting. Surg Endosc 35, 165–173 (2021). https://doi.org/10.1007/s00464-020-07375-0

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