Early and Late Complications after Surgery for MEN1-related Nonfunctioning Pancreatic Neuroendocrine Tumors
Objective: To estimate short and long-term morbidity after pancreatic surgery for multiple endocrine neoplasia type 1 (MEN1)-related nonfunctioning pancreatic neuroendocrine tumors (NF-pNETs).
Background: Fifty percent of the MEN1 patients harbor multiple NF-pNETs. The decision to proceed to NF-pNET surgery is a balance between the risk of disease progression versus the risk of surgery-related morbidity. Currently, there are insufficient data on the surgical complications after MEN1 NF-pNET surgery.
Methods: MEN1 patients diagnosed with a NF-pNET who underwent surgery were selected from the DutchMEN1 study group database, including >90% of the Dutch MEN1 population. Early postoperative complications, new-onset diabetes mellitus, and exocrine pancreatic insufficiency were captured.
Results: Sixty-one patients underwent NF-pNET surgery at 1 of the 8 Dutch academic centers. Patients were young (median age 41 years) with low American Society of Anesthesiologists scores. Median NF-pNET size on imaging was 22mm (3-157). Thirty-three percent (19/58) of the patients developed major early - Clavien-Dindo grade III to IV - complications mainly consisting International Study Group of Pancreatic Surgery grade B/C pancreatic fistulas. Twenty-three percent of the patients (14/61) developed endocrine or exocrine pancreas insufficiency. The development of major early postoperative complications was independent of the NF-pNET tumor size. Twenty-one percent of the patients (12/58) developed multiple major early complications.
Conclusions: MEN1 NF-pNET surgery is associated with high rates of major short and long-term complications. Current findings should be taken into account in the shared decision-making process when MEN1 NF-pNET surgery is considered.
|Keywords||multiple endocrine neoplasia type 1, neuroendocrine tumors, pancreas, surgery|
|Persistent URL||dx.doi.org/10.1097/SLA.0000000000002050, hdl.handle.net/1765/112833|
|Journal||Annals of Surgery|
Nell, S, Borel Rinkes, I.H.M, Verkooijen, H.M, Bonsing, B.A, van Eijck, C.H.J, van Goor, H, … Vriens, M.R. (2018). Early and Late Complications after Surgery for MEN1-related Nonfunctioning Pancreatic Neuroendocrine Tumors. Annals of Surgery, 267(2), 352–356. doi:10.1097/SLA.0000000000002050