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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

Annals of Surgical Oncology volume 28, pages 7742–7758 (2021)Cite this article

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.

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Acknowledgments

The authors thank the members of Korean Pancreas Surgery Club for their active contribution to this study: In Seok Choi (Department of Surgery, Konyang University College of Medicine, Daejeon, Korea), Sun-Whe Kim (Department of Surgery, National Cancer Center, Goyang, Korea), Woo Jung Lee (Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul, Korea), In Woong Han (Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea), Dong Sup Yoon (Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea), Koo Jeong Kang (Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Keimyung University Dongsan Hospital, Daegu, Korea), Seog Ki Min (Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea), Hyeon Kook Lee (Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea), Soon Chan Hong (Department of Surgery, Gyeongsang National University College of Medicine, Jinju, Korea).

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Author notes

  1. Ho Kyoung Hwang and Ki Byung Song have equally contributed as first authors.

Authors and Affiliations

  1. Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul, Korea

    Ho Kyoung Hwang MD, PhD & Chang Moo Kang MD, PhD

  2. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea

    Ki Byung Song MD, PhD, Dae Wook Hwang MD, PhD & Song Cheol Kim MD, PhD

  3. Department of Statistics, Keimyung University, Daegu, Korea

    Minsu Park MD, PhD

  4. Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

    Wooil Kwon MD, PhD & Jin-Young Jang MD, PhD

  5. Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Jin Seok Heo MD, PhD & Dong Wook Choi MD, PhD

  6. Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

    Joon Seong Park MD, PhD

  7. Department of Hepatobiliary and Pancreas Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Tae Ho Hong MD, PhD

  8. Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Jeollanamdo, Korea

    Chol Kyoon Cho MD, PhD

  9. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Keimyung University Dongsan Hospital, Daegu, Korea

    Keun Soo Ahn MD, PhD

  10. Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea

    Huisong Lee MD, PhD

  11. Department of Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea

    Seung Eun Lee MD, PhD

  12. Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Korea

    Chi-Young Jeong MD, PhD

  13. Department of Surgery, Dong-A University College of Medicine, Busan, Korea

    Young Hoon Roh MD, PhD

  14. Department of Surgery, Chonnam National University Hospital, Gwangju, Korea

    Hee Joon Kim MD, PhD

  15. Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea

    Ho-Seong Han MD, PhD & Yoo-Seok Yoon MD, PhD

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  1. Ho Kyoung Hwang MD, PhD
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Consortia

for the Korean Pancreas Surgery Club

  • In Seok Choi
  • , Sun-Whe Kim
  • , Woo Jung Lee
  • , In Woong Han
  • , Dong Sup Yoon
  • , Koo Jeong Kang
  • , Seog Ki Min
  • , Hyeon Kook Lee
  •  & Soon Chan Hong

Corresponding author

Correspondence to Yoo-Seok Yoon MD, PhD.

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Hwang, H.K., Song, K.B., Park, M. et al. 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. Ann Surg Oncol 28, 7742–7758 (2021). https://doi.org/10.1245/s10434-021-10092-0

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  • DOI: https://doi.org/10.1245/s10434-021-10092-0