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

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

Research output: Contribution to journalArticle

16 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1-12
Number of pages12
JournalJournal of Gastrointestinal Surgery
DOIs
StateAccepted/In press - Mar 2 2017

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Keywords

  • Enucleation
  • Nonsurgical management
  • Observation
  • Operative outcomes
  • Pancreatic neuroendocrine tumor (panNET)
  • Parenchyma-sparing surgery
  • Resection
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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