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Pancreatic Neuroendocrine Tumors (panNETs): Analysis of Overall Survival of Nonsurgical Management Versus Surgical Resection

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Outcomes of patients with pancreatic neuroendocrine tumors (panNETs) undergoing surgical or nonsurgical management and outcomes of enucleation versus standard resection were compared.

Methods

MEDLINE, EMBASE, PubMed, Scopus, and Cochrane were queried (2000 to present). All studies comparing patients undergoing surgical versus nonsurgical treatments, or enucleation versus standard resection, were included. Pooled risk ratios and 95% CI for survival were calculated.

Results

Eleven studies met criteria with 1491 resected and 1607 nonsurgically managed patients. Meta-analysis showed improved overall survival with resection at 1 year (risk ratio (RR) = 1.281, CI 1.064–1.542, p = 0.009), 3 years (RR = 1.837, CI 1.594–2.117, p < 0.001), and 5 years (RR = 2.103, CI 1.50–2.945, p < 0.001). OS of patients with resected nonfunctioning panNETs was improved at 3 years (RR = 1.847, CI 1.477–2.309, p < 0.001) and 5 years (RR = 1.767, CI 1.068–2.924, p = 0.027). OS was improved when panNETs ≤2 cm were resected at 3 years (RR = 1.695, CI 1.269–2.264, p < 0.001) and 5 years (RR = 2.210, CI 1.749–2.791, p < 0.001). Fifteen articles met criteria for enucleation versus standard resection (n = 1035; 620 were nonfunctioning). Enucleation had shorter operative time (weighted mean difference (WMD) = −95.6 min, 95% CI −131.4 to −59.8, p < 0.01), less operative blood loss (WMD = −172.6 ml, 95% CI −340 to −5.1, p = 0.04), but increased postoperative pancreatic fistula (POPF) (RR = 2.08, 95% CI 1.39–3.12, p < 0.01).

Conclusion

Surgical resection of panNETs, including small and nonfunctioning, appears to be associated with improved OS. Enucleation is associated with shorter operative time, less blood loss, but greater incidence of POPF. Prospective, randomized clinical trials are needed to confirm these results.

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Author notes

    Authors and Affiliations

    1. Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA

      Paige Finkelstein, Rishika Sharma, Omar Picado, Rahul Gadde, Heather Stuart, Caroline Ripat, Alan S. Livingstone, Danny Sleeman, Nipun Merchant & Danny Yakoub

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    1. Paige Finkelstein
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    All authors listed have substantially contributed to this paper and have met criteria for the definition of authorship.

    Paige Finkelstein and Rishika Sharma contributed equally to this work.

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    Finkelstein, P., Sharma, R., Picado, O. et al. Pancreatic Neuroendocrine Tumors (panNETs): Analysis of Overall Survival of Nonsurgical Management Versus Surgical Resection. J Gastrointest Surg 21, 855–866 (2017). https://doi.org/10.1007/s11605-017-3365-6

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