Ann Hepatobiliary Pancreat Surg.  2025 May;29(2):168-176. 10.14701/ahbps.24-215.

A comprehensive study on postoperative complications and postoperative pancreatic fistula in sporadic non-functional pancreatic neuroendocrine tumors: A retrospective cohort study

• Kim J
• Hong SS
• Kim SH
• Hwang HK
• Kang CM

• KMID: 2568265
• DOI: http://doi.org/10.14701/ahbps.24-215

Abstract

Backgrounds/Aims
Balancing surgical risks and benefits is crucial for managing non-functional pancreatic neuroendocrine tumors (NF-PNETs). Despite high postoperative pancreatic fistula (POPF) rates, studies on postoperative complications of sporadic NFPNETs are scarce. Thus, this study aimed to investigate postoperative complications and identify risk factors for POPF.
Methods
A retrospective review of 166 NF-PNET surgeries performed at Severance Hospital between February 2000 and August 2023 was conducted.
Results
Age > 65 years and higher American Society of Anesthesiology (ASA) grade were not significantly correlated with severe complications (odds ratio [OR]: 1.10, p = 0.871 and OR: 1.47, p = 0.491, respectively). Surgical procedures included enucleation (13.9%), distal pancreatectomy (50.0%), central pancreatectomy (4.8%), pancreaticoduodenectomy (PD) (26.5%), and total pancreatectomy (4.8%). Severe complications occurred in 12.05% of surgeries. The overall incidence of all POPFs including biochemical leaks was 53%, while clinically relevant POPF (grade B or C) occurred in 7.8% of patients. Logistic regression showed that PD (OR: 3.94, p = 0.092) tended to be risk factor for POPF and that diameter of the main pancreatic duct (MPD) ≤ 3 mm was a significant risk factor for POPF (OR: 0.22, p = 0.008). A pancreas thickness (PT)/MPD ratio > 4.47 on preoperative computed tomography predicted all POPFs in PD patients (OR: 11.70, p = 0.001).
Conclusions
Age and comorbidities had no significant impact on surgical outcomes. PD was associated with higher serious complications and POPF rates. The PT/MPD ratio is a valuable preoperative tool for predicting POPF risk in PD patients.

Keyword

Gastro-enteropancreatic neuroendocrine tumor; Pancreatectomy; Postoperative complications; Pancreatic fistula; Risk factors

Reference

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