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Short- and long-term outcomes of laparoscopic organ-sparing resection in pancreatic neuroendocrine tumors: a single-center experience

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Abstract

Background

Laparoscopic organ-sparing pancreatectomy (LOSP) is an ideal therapeutic option in selected cases of pancreatic neuroendocrine tumors (PNETs). Nevertheless, given the low frequency of PNETs, there is scarce evidence regarding short and particularly long-term outcomes of LOSP in this clinical setting.

Methods

All patients with PNETs who underwent surgery (under a LOSP policy) were retrospectively reviewed from a prospective database maintained at our center. Preoperative characteristics, operative data, pathological features and postoperative outcomes were analyzed.

Results

Between December 2003 and December 2015, 36 patients with PNETs underwent laparoscopic resections. Ten were functional tumors, 26 non-functional and 16 were “incidental” cases. The following procedures were performed: one enucleation, eight central pancreatectomies (LCP), one resection of the uncinate process and 26 distal pancreatectomies (DP) (15 of them laparoscopic vessels-preserving). There were no conversions to open surgery, and no drains were routinely left. Mean operative time was 288 min (SD 99). Hospital stay was 6 days. Eighteen patients (50%) experienced some complication of which most were mild (Clavien–Dindo I/II). Three postoperative bleedings occurred: two grade B/one grade C; two required laparoscopic reoperation. Thirteen (36.1%) patients developed peripancreatic fluid collections: two were symptomatic and were managed with transgastric drainage (one presented post-puncture abscesification requiring surgical drainage and splenectomy). Four patients (11%)—one DP and three LCP—developed new-onset pancreatogenic diabetes mellitus (NODM) in the long term. According to the European Neuroendocrine Tumor Society, 19 cases were stage I, seven IIA, two IIIA, one IIIB and seven stage IV. Over a mean follow-up of 51 months, two patients died, one due to recurrence of the tumor and another due to cirrhosis.

Conclusions

The existing different surgical options must be individually considered according to the location and particular characteristics of every tumor. Results from this single-center study document the effectiveness of LOSP in selected cases of PNETs.

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Abbreviations

PNETs:

Pancreatic neuroendocrine tumors

LOSP:

Laparoscopic organ-sparing pancreatectomy

LCP:

Laparoscopic central pancreatectomy

DP:

Distal pancreatectomy

LVPDP:

Laparoscopic vessels-preserving distal pancreatectomy

NODM:

New-onset pancreatogenic diabetes mellitus

LEN:

Enucleation

LDP:

Laparoscopic distal pancreatectomy

WD:

Wirsung duct

LRDPS:

Laparoscopic radical distal pancreatosplenectomy

RAMPS:

Radical anterograde modular pancreatosplenectomy

SD:

Standard deviation

CT:

Multislice computer tomography

MRI:

Magnetic resonance imaging

EUS:

Endoscopic ultrasound

ENETS:

European neuroendocrine society

FNA:

Fine-needle aspiration

BMI:

Body mass index

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Acknowledgements

The authors are grateful to Paul Miller Ph.D. for his help with the English and Lydia Munárriz for transcribing the manuscript.

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Authors and Affiliations

  1. Department of General Surgery, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Av. Pío XII, 36, 31008, Pamplona, Spain

    Javier A. Cienfuegos, Joseba Salguero, Sira Ocaña, Gabriel Zozaya, Pablo Martí-Cruchaga, Fernando Pardo, José Luis Hernández-Lizoáin & Fernando Rotellar

  2. Central Clinical Trials Unit, Research Support Service, Clínica Universidad de Navarra, Pamplona, Spain

    Jorge M. Núñez-Córdoba

  3. Department of Preventive Medicine and Public Health, Medical School, University of Navarra, Pamplona, Spain

    Jorge M. Núñez-Córdoba & Miguel Ruiz-Canela

  4. Abdominal Radiology, Department of Radiology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain

    Alberto Benito

  5. Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain

    Javier A. Cienfuegos, Joseba Salguero, Jorge M. Núñez-Córdoba, Miguel Ruiz-Canela, Alberto Benito, Sira Ocaña, Gabriel Zozaya, Pablo Martí-Cruchaga, Fernando Pardo, José Luis Hernández-Lizoáin & Fernando Rotellar

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  1. Javier A. Cienfuegos
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  11. Fernando Rotellar
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Correspondence to Fernando Rotellar.

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Javier A. Cienfuegos, Joseba Salguero, Núñez-Córdoba Jorge M, Miguel Ruiz-Canela, Alberto Benito, Sira Ocaña, Gabriel Zozaya, Pablo Martí-Cruchaga, Fernando Pardo, José Luis Hernández-Lizoáin and Fernando Rotellar have no conflicts of interest or financial ties to disclose.

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Cienfuegos, J.A., Salguero, J., Núñez-Córdoba, J.M. et al. Short- and long-term outcomes of laparoscopic organ-sparing resection in pancreatic neuroendocrine tumors: a single-center experience. Surg Endosc 31, 3847–3857 (2017). https://doi.org/10.1007/s00464-016-5411-y

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