Amir Ebadinejad, Ashrita Raghuram, Sophia Xiao, Ethan Angle, Hassan Aziz
Concurrent liver-directed surgery was not associated with an increase in 30-day morbidity or mortality after pancreatectomy for pNETs. These findings support the safety of concurrent hepatic resection in appropriately selected pNET patients.
BACKGROUND AND OBJECTIVES: Pancreatic neuroendocrine tumors (pNETs) account for 1%-2% of pancreatic tumors, with an increasing incidence. The safety of concurrent pancreas-liver resections remains uncertain. This study evaluated the national outcomes of concurrent pancreatectomy and liver-directed surgery for pNETs.
METHODS: ACS-NSQIP (2019-2023) was queried for adult patients who underwent pancreatectomy for pNETs. Concurrent liver-directed procedures were identified by CPT code and classified as hepatectomy or ablation alone; patients were grouped as isolated pancreatectomy, concurrent hepatectomy, or concurrent ablation alone. Pre-, intra-, and postoperative characteristics were compared using inferential statistics. Multivariable logistic regression identified predictors of 30-day morbidity, readmission, reoperation, and mortality, with Firth penalized likelihood used for rare outcomes.
RESULTS: Of 4794 patients, 4587 (95.7%) underwent isolated pancreatectomy, 172 (3.6%) underwent concurrent hepatectomy, and 35 (0.7%) underwent concurrent ablation alone. Concurrent hepatectomy was parenchymal-sparing in 163 of 172 patients (94.8%); only nine patients underwent a major hepatectomy. Overall morbidity was similar across groups (38.8%, 45.9%, and 42.9%; p = 0.154), as was serious morbidity (28.7%, 27.9%, 22.9%; p = 0.730) and 30-day mortality (1.0%, 0.6%, 0%). On multivariable analysis, neither concurrent hepatectomy (OR 1.02, 95% CI 0.71-1.48) nor concurrent ablation (OR 0.94, 95% CI 0.46-1.93) was associated with morbidity. Pancreatoduodenectomy was associated with morbidity (OR 2.38, 95% CI 2.05-2.76), reoperation (OR 2.16, 95% CI 1.52-3.08), and mortality (OR 2.50, 95% CI 1.39-4.50), and a minimally invasive approach was associated with lower morbidity (OR 0.69, 95% CI 0.60-0.80).
CONCLUSIONS: Concurrent liver-directed surgery was not associated with an increase in 30-day morbidity or mortality after pancreatectomy for pNETs. These findings support the safety of concurrent hepatic resection in appropriately selected pNET patients.