Complications of surgery for gastro-entero-pancreatic neuroendocrine neoplasias

Langenbecks Arch Surg. 2020 Mar;405(2):137-143. doi: 10.1007/s00423-020-01869-0. Epub 2020 Apr 15.

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.

Keywords: Gastro-entero-pancreatic system; Neuroendocrine neoplasia; Pancreas; Perioperative complications; Small intestine; Surgery.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Gastrointestinal Neoplasms / pathology
  • Gastrointestinal Neoplasms / surgery*
  • Humans
  • Male
  • Middle Aged
  • Neuroendocrine Tumors / pathology
  • Neuroendocrine Tumors / surgery*
  • Pancreatic Neoplasms / pathology
  • Pancreatic Neoplasms / surgery*
  • Postoperative Complications / epidemiology*
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • Young Adult