Short‐ and Long‐Term Outcomes of Laparoscopic Organ‐Sparing Resection for Pancreatic Neuroendocrine Neoplasms

Abstract

Background Pancreatic neuroendocrine neoplasms (PNENs) are rare neoplasm with long life expectancy. In this setting, patients may benefit from laparoscopic organ-sparing resection. There are few reports of laparoscopic organ-sparing resection for PNENs. The aim of this study was to evaluate the Short-and long-term outcomes of laparoscopic organ-sparing resection for PNENs. Methods A retrospective study was performed for patients with PNENs who underwent laparoscopic organsparing pancreatectomy between March 2005 and May 2018. The patients' demographic data, operative results, pathological reports, hospital courses, morbidity and mortality, and follow-up data (including pancreatic function, till August 2018) was analyzed. Results Thirty-five patients were identified. There were 9 male and 26 female patients, with a median age of 46 years (range, 25-75 years). The mean BMI was 24.6±3.3kg/m 2. Nine patients received laparoscopic enucleation, 20 received laparoscopic spleen-preserving distal pancreatectomy, and 6 received laparoscopic central pancreatectomy. The operative time, intraoperative blood loss, transfusion rate, postoperative hospital stay were 186.4±60.2min, 165±73.0ml, 0, 9d(range, 5-23d), respectively. The morbidity rate, ≥Grade Ⅲ complication rate and ≥grade B pancreatic fistula rate were 34.2%, 11.4%, 8.7%, respectively, with no mortality. The rate of follow-up was 94.3%, and the median follow-up time was 55 months (range, 3-158months). One patients had diabetes after laparoscopic spleen-preserving distal pancreatectomy, no patient had symptom of pancreatic exocrine insufficiency. One patient developed recurrence 36 months after laparoscopic enucleation and was managed with surgical resection. The other patients survived without metastases or recurrence during the follow-up. Conclusions Laparoscopic organ-sparing resection for selected cases of PNENs is safe and feasible, and have favorable short-and long-term outcome.

Analysis of the clinical efficacy of laparoscopic middle pancreatectomy in the treatment of benign or low-grade malignant tumors of the pancreas

“…MP maximized the preservation of normal physiological function of the pancreas while performing tumor resection, resulting in better preservation of endocrine function, which was significantly lower than other types of pancreatic surgery in comparison and could improve the postoperative quality of life of the patients (1,2,23,(33)(34)(35)(36). In terms of endocrine function, the persistence of NODM was observed in benign or malignant tumors after PD with similar incidence.…”

“…However, it is a hot topic of current research to preserve the organ function and maintain physiological access while reducing the incidence of postoperative complications and quality of life after surgical intervention for benign or malignant tumors of the pancreas. For benign and junctional tumors of the pancreas, restrictive pancreatic resection procedures, namely, middle pancreatectomy (MP), local enucleation, and subtotal resection with preservation of the mid-pancreatic segment, have been proposed to obtain better functional outcomes without compromising the radicality of the tumor in the treatment of benign or low-grade malignant tumors (1,2). However, in the treatment of benign and junctional tumors of the pancreas, laparoscopic MP offers less experience to draw from because of its surgical difficulty and the limited number of cases.…”

Long-term Outcomes of Parenchyma-sparing and Oncologic Resections in Patients With Nonfunctional Pancreatic Neuroendocrine Tumors <3 cm in a Large Multicenter Cohort

“…Improved imaging modalities have led to an increased rate of incidentally discovered small sporadic nonfunctional PNETs 19. While the NANET and ENET guidelines, based on retrospective studies, recommend observation for small nonfunctioning PNETs < 2 cm with no evidence of invasion, the surgical management of PNETs <3 cm remains controversial 20. For lesions <2 cm, the ongoing prospective observational trial evaluating oncologic safety of observation in PNETs <2 cm will allow for improved evidence-based guidance (ASPEN, NCT03084770) 21…”

“…19 While the NANET and ENET guidelines, based on retrospective studies, recommend observation for small nonfunctioning PNETs < 2 cm with no evidence of invasion, the surgical management of PNETs <3 cm remains controversial. 20 For lesions <2 cm, the ongoing prospective observational trial evaluating oncologic safety of observation in PNETs <2 cm will allow for improved evidence-based guidance (ASPEN, NCT03084770). 21 For those patients who are considered for surgical removal of their PNETs PSR compared to oncologic resections have been actively debated.…”

Organ-Sparing Pancreatectomy for Benign or Low-Grade Malignant Pancreatic Tumors: A Single-Center Experience with 101 Consecutive Patients

“…As a fact, the quality of life following surgical intervention should be considered for patients with benign or low-grade-malignant pancreatic lesions having excellent long-term survival. In recent years, there has been a growing interest in organ-sparing pancreatectomy to achieve better functional results without compromising oncological radicality for treating benign or low-grade malignant tumors [ 5 – 8 ]. This study aimed to investigate the short- and long-term outcomes of organ-sparing pancreatectomy for benign or low-grade malignant pancreatic tumors in a single center over 12 years.…”