Early and Late Complications After Surgery for MEN1-related Nonfunctioning Pancreatic Neuroendocrine Tumors. Issue 2 (February 2018)

• Record Type: Journal Article
• Authors: Nell, Sjoerd; Borel Rinkes, Inne H. M.; Verkooijen, Helena M.; Bonsing, Bert A.; van Eijck, Casper H.; van Goor, Harry; de Kleine, Ruben H. J.; Kazemier, Geert; Nieveen van Dijkum, Elisabeth J.; Dejong, Cornelis H. C.; Valk, Gerlof D.; Vriens, Menno R.
• Is Part Of: Annals of surgery. Volume 267:Issue 2(2018:Feb.)
• Publication Date: 2018-02
• Subjects: multiple endocrine neoplasia type 1 -- neuroendocrine tumors -- pancreas -- surgery; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000002050
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : 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 22 mm (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.