Published online Oct 15, 2020. doi: 10.4251/wjgo.v12.i10.1133
Peer-review started: June 21, 2020
First decision: July 30, 2020
Revised: August 17, 2020
Accepted: September 14, 2020
Article in press: September 14, 2020
Published online: October 15, 2020
Processing time: 115 Days and 9.6 Hours
The mainstay of treatment for nonfunctioning (NF)-pancreatic neuroendocrine tumors (PNETs) is surgical resection. Minimally invasive approaches to pancreatic resection are not yet widely accepted as NF-PNET treatment.
Some studies have shown laparoscopic distal pancreatectomy of NF-PNETs as producing post-operative complications and oncological outcomes that are comparable to the open approach. However, the long-term oncological outcomes of minimally invasive approaches to pancreaticoduodenectomies and other types of surgery for treating NF-PNETs remain unknown.
The current study was designed to determine the short- and long-term outcomes of minimally invasive pancreas resection conducted on patients with NF-PNETs.
Severance Hospital’s prospective databases were searched for patients who underwent curative resections for NF-PNETs between January 2003 and August 2018. Patients who underwent pancreatectomy in combination with resection were excluded.
Groups of patients who underwent proximal pancreas resections (central pancreatectomies, pancreaticoduodenectomies, and total pancreatectomies), open resection, and minimally invasive resection showed similar levels of post-operative complications. The groups showed no difference between the rates of post-operative pancreatic fistulae. However, PNET patients showed high risk of forming post-operative pancreatic fistulae, due to the softness of the pancreas and small diameter of its ducts. Large tumor size, poor differentiation, and lympho-vascular invasion were associated with NF-PNET tumor recurrence.
Minimally invasive approaches of pylorus-preserving pancreaticoduodenectomy, central pancreatectomy, and total pancreatectomy led to comparable post-operative complication rates and short-term outcomes. The type of surgical approach (minimally invasive vs open) was not an independent prognostic factor in treating NF-PNET patients [Exp(β) = 1.062, P = 0.929]. Regardless of the type of surgery, a minimally invasive approach could be safe and feasible for select NF-PNETs patients who are undergoing pancreas resection.
The current study of minimally invasive pancreatic surgeries collectively evaluated laparoscopic and robotic approaches. Future studies should involve comparison of the two ¾ laparoscopic vs robotic ¾ in treating PNET patients. Furthermore, use of the latest criteria to select resected PNET patients may help improve prognosis of the minimally invasive approach.