Patient selection, utilization trends, and short-term postoperative outcomes for minimally invasive versus open resection of small bowel neuroendocrine tumors

Abstract

Introduction: Minimally invasive surgery (MIS) has been increasingly used for the treatment of small bowel neuroendocrine tumors (SBNETs). Although some studies have found comparable oncologic outcomes for appropriately selected patients undergoing an MIS approach, comprehensive perioperative outcomes remain insufficiently characterized in this patient population. We sought to evaluate short-term postoperative outcomes of MIS vs open resection of SBNETs in a large national cohort.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent open or laparoscopic/robotic resection of SBNETs from 2012 to 2022. Postoperative outcomes were compared using univariable and multivariable analyses before and after 1:1 propensity-score matching.

Results: Of 2096 eligible patients, 848 (40%) underwent MIS resections. On multivariable logistic regression of the overall cohort, the MIS approach was associated with a significantly lower likelihood of experiencing a postoperative complication (adjusted odds ratio, 0.46; P <.001). After propensity-score matching, the MIS approach was associated with a significantly shorter length of stay (4 vs 6 days; P <.001) and fewer skin/soft tissue infections (2.1% vs 6.8%; P <.001), urinary tract infections (0.5% vs 2.4%; P =.004), occurrences of sepsis (0.2% vs 1.2%; P =.038), and blood transfusions (2.4% vs 4.8%; P =.019).

Conclusion: MIS approaches for SBNET resection are associated with improved short-term perioperative outcomes and, when deemed appropriate based on oncologic considerations, should be part of a surgical oncologist's armamentarium.

Keywords: MIS; Minimally invasive surgery; NSQIP; National Surgical Quality Improvement Program; SBNET; Small bowel neuroendocrine tumor.