Early and Late Complications after Surgery for MEN1-related Nonfunctioning Pancreatic Neuroendocrine Tumors

Sjoerd Nell, Inne H. M. Borel Rinkes, Helena M. Verkooijen, Bert A. Bonsing, Casper H. van Eijck, Harry van Goor, Ruben H. J. de Kleine, Geert Kazemier, Elisabeth J. Nieveen van Dijkum, Cornelis H. C. Dejong, Gerlof D. Valk, Menno R. Vriens

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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 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.
Original languageEnglish
Pages (from-to)352-356
JournalAnnals of Surgery
Volume267
Issue number2
DOIs
Publication statusPublished - 2018

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