Ho Kyoung Hwang1, Ki Byung Song2, Minsu Park3, Wooil Kwon4, Jin-Young Jang4, Jin Seok Heo5, Dong Wook Choi5, Chang Moo Kang1, Joon Seong Park6, Tae Ho Hong7, Chol Kyoon Cho8, Keun Soo Ahn9, Huisong Lee10, Seung Eun Lee11, Chi-Young Jeong12, Young Hoon Roh13, Hee Joon Kim14, Dae Wook Hwang2, Song Cheol Kim2, Ho-Seong Han15, Yoo-Seok Yoon16. 1. Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul, Korea. 2. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea. 3. Department of Statistics, Keimyung University, Daegu, Korea. 4. Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. 5. Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 6. Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. 7. Department of Hepatobiliary and Pancreas Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. 8. Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Jeollanamdo, Korea. 9. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Keimyung University Dongsan Hospital, Daegu, Korea. 10. Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea. 11. Department of Surgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea. 12. Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Korea. 13. Department of Surgery, Dong-A University College of Medicine, Busan, Korea. 14. Department of Surgery, Chonnam National University Hospital, Gwangju, Korea. 15. Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea. 16. Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea. yoonys@snubh.org.
Abstract
BACKGROUND: Limited evidence exists for the safety and oncologic efficacy of minimally invasive surgery (MIS) for nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs) according to tumor location. This study aimed to compare the surgical outcomes of MIS and open surgery (OS) for right- or left-sided NF-PNETs. METHODS: The study collected data on patients who underwent surgical resection (pancreatoduodenectomy, distal/total/central pancreatectomy, duodenum-preserving pancreas head resection, or enucleation) of a localized NF-PNET between January 2000 and July 2017 at 14 institutions. The inverse probability of treatment-weighting method with propensity scores was used for analysis. RESULTS: The study enrolled 859 patients: 478 OS and 381 MIS patients. A matched analysis by tumor location showed no differences in resection margin, intraoperative blood loss, or complications between MIS and OS. However, MIS was associated with a longer operation time for right-sided tumors (393.3 vs 316.7 min; P < 0.001) and a shorter postoperative hospital stay for left-sided tumors (8.9 vs 12.9 days; P < 0.01). The MIS group was associated with significantly higher survival rates than the OS group for right- and left-sided tumors, but survival did not differ for the patients divided by tumor grade and location. Multivariable analysis showed that MIS did not affect survival for any tumor location. CONCLUSION: The short-term outcomes offered by MIS were comparable with those of OS except for a longer operation time for right-sided NF-PNETs. The oncologic outcomes were not compromised by MIS regardless of tumor location or grade. These findings suggest that MIS can be performed safely for selected patients with localized NF-PNETs.
BACKGROUND: Limited evidence exists for the safety and oncologic efficacy of minimally invasive surgery (MIS) for nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs) according to tumor location. This study aimed to compare the surgical outcomes of MIS and open surgery (OS) for right- or left-sided NF-PNETs. METHODS: The study collected data on patients who underwent surgical resection (pancreatoduodenectomy, distal/total/central pancreatectomy, duodenum-preserving pancreas head resection, or enucleation) of a localized NF-PNET between January 2000 and July 2017 at 14 institutions. The inverse probability of treatment-weighting method with propensity scores was used for analysis. RESULTS: The study enrolled 859 patients: 478 OS and 381 MIS patients. A matched analysis by tumor location showed no differences in resection margin, intraoperative blood loss, or complications between MIS and OS. However, MIS was associated with a longer operation time for right-sided tumors (393.3 vs 316.7 min; P < 0.001) and a shorter postoperative hospital stay for left-sided tumors (8.9 vs 12.9 days; P < 0.01). The MIS group was associated with significantly higher survival rates than the OS group for right- and left-sided tumors, but survival did not differ for the patients divided by tumor grade and location. Multivariable analysis showed that MIS did not affect survival for any tumor location. CONCLUSION: The short-term outcomes offered by MIS were comparable with those of OS except for a longer operation time for right-sided NF-PNETs. The oncologic outcomes were not compromised by MIS regardless of tumor location or grade. These findings suggest that MIS can be performed safely for selected patients with localized NF-PNETs.
Authors: Xu-Feng Zhang; Alexandra G Lopez-Aguiar; George Poultsides; Eleftherios Makris; Flavio Rocha; Zaheer Kanji; Sharon Weber; Ryan Fields; Bradley A Krasnick; Kamran Idrees; Paula M Smith; Cliff Cho; Carl R Schmidt; Shishir K Maithel; Timothy M Pawlik Journal: J Surg Oncol Date: 2019-04-18 Impact factor: 3.454