Complications of surgery for gastro-entero-pancreatic neuroendocrine neoplasias

Abstract

Purpose Surgery is recommended for most patients with gastro-entero-pancreatic neuroendocrine neoplasias (GEP-NENs). Rates of complications and perioperative mortality have been reported in few mostly retrospective single-center series, but there has been no detailed analysis on risk factors for perioperative complications and mortality to date. Methods Data of patients with GEP-NENs operated between January 2015 and September 2018 were retrieved from EUROCRINE©, a European online endocrine surgical quality registry, and analyzed regarding rate and risk factors of surgical complications. Risk factors were assessed by logistic regression. Results Some 376 patients (211 female, 167 male; age median 63, range 15-89 years) were included. Most NENs were located in the small intestine (SI) (n = 132) or pancreas (n = 111), the rest in the stomach (n = 34), duodenum (n = 30), appendix (n = 30), colon, and rectum (n = 22), or with unknown primary (n = 15). Of the tumors, 320 (85.1%) were well or moderately differentiated, and 147 (39.1%) of the patients had distant metastases at the time of operation. Severe complications (Dindo-Clavien ≥ 3) occurred in 56 (14.9%) patients, and 4 (1.1%) patients died perioperatively. Severe complications were more frequent in surgery for duodenopancreatic NENs (n = 31; 22.0%) compared with SI-NENs (n = 15; 11.4%) (p = 0.014), in patients with lymph node metastases operated with curative aim of surgery (n = 24; 21.4%) versus non-metastasized tumors or palliative surgery (n = 32; 12.1%) (p = 0.020), and in functioning tumors (n = 20; 23.0%) versus non-functioning tumors (n = 30; 13.5%) (p = 0.042). Complication rates were not significantly associated with tumor stage or grade. Conclusions Severe complications are frequent in GEP-NEN surgery. Besides duodenopancreatic tumor location, curative resection of nodal metastases and functioning tumors are risk factors for complications.

Resection of Non-Functional Pancreatic Neuroendocrine Neoplasms—A Single-Center Retrospective Outcome Analysis

“…In pancreatic neuroendocrine neoplasms (pNEN), the association between the surgical access [1,2], the extent of resection [3][4][5], simultaneous lymphadenectomy [6] and the patient's oncological outcome is a subject of discussion. However, severe postoperative complications are frequent and occur in 15.6% of the patients after surgery for gastroentero-pancreatic neuroendocrine neoplasm (NEN) [7].…”

Postoperative morbidity and mortality after surgical resection of small bowel neuroendocrine neoplasms: A systematic review and meta‐analysis

“…Albers et al 13 recently analysed data concerning postoperative complications using the EUROCRINE registry, a European online endocrine surgical quality registry. They included 133 patients across 23 centres from nine different countries who underwent resection of a SB‐NEN.…”

“…Because mesenteric tumour masses can have a close relationship with the main mesenteric trunks, vascularisation of the small bowel may be at risk during central mesenteric dissection. Other potential complications after surgery for SB‐NEN include postoperative haemorrhage, surgical site infections, abscess and anastomotic leakage 13 …”

Management of incidentally discovered appendiceal neuroendocrine tumors after an appendicectomy

“…Patients who undergo CRH for aNETs are younger and have fewer comorbidities than typical patients with colon cancer. Nevertheless, the rate of major complications after a colectomy for aNETs ranges from 5% to 15%[ 28 , 36 , 37 ]. A systematic review and meta-analysis conducted by Ricci et al [ 30 ] found that when performing a CRH in aNETs > 2 cm, the number needed to treat was five, while the number needed to harm was six, suggesting that the risk was similar to the possible benefit.…”