Surgical Complications in Gastro-Entero-Pancreatic Neuroendocrine Neoplasms
Overview
This study analyzed 376 patients undergoing surgery for gastro-entero-pancreatic neuroendocrine neoplasms (GEP-NEN) across 23 centers in 9 countries. It identified complication rates, common postoperative issues, and risk factors associated with severe surgical complications.
Background
GEP-NENs are a diverse group of tumors with increasing incidence worldwide, now approximately 3.5 per 100,000. Surgery remains a primary treatment modality recommended by international guidelines, alongside other therapies such as peptide receptor radionuclide therapy and chemotherapy. Understanding surgical complications is critical, as many patients live long-term with these tumors, necessitating a balance between treatment benefits and risks.
Data Highlights
Parameter
Value
Number of patients
376
Female patients
211 (55.8%)
Male patients
167 (44.2%)
Median age
63 years (range 15–89)
Most common tumor localization
Small intestine (34.9%)
Second most common localization
Pancreas (29.4%)
WHO tumor grading available
361 patients
NET G1
141 (39.1%)
NET G2
180 (49.9%)
NET G3
6 (1.7%)
NEC G3
13 (3.6%)
Mixed neuroendocrine-non-neuroendocrine (MiNEN)
5 (1.4%)
Stage IV tumors
147 (39.9%)
Functioning tumors
87 (23.1%)
Key Findings
Overall surgical complication rates in GEP-NEN range from 5% to 35%, varying by tumor location and surgery type.
Pancreatic fistula is the most frequent complication after pancreatic neuroendocrine tumor surgery, especially following enucleations.
Common complications after small intestinal NEN resections include hemorrhage, small bowel obstruction, and local infections.
More than half of complications after duodenopancreatic surgery are pancreatic fistulas.
Risk factors for severe complications were analyzed using multivariate logistic regression, though specific risk factors are not detailed in the provided text.
Clinical Implications
Clinicians should be aware of the relatively high risk of pancreatic fistula following pancreatic NEN surgery, particularly after enucleations, and monitor patients accordingly. Surgical planning should consider tumor location and type to minimize complications such as hemorrhage and bowel obstruction. The use of standardized complication grading and multicenter data can guide risk stratification and patient counseling.
Conclusion
Surgical treatment of GEP-NEN is associated with a significant risk of complications that vary by tumor site and surgical procedure. Understanding these risks is essential to optimize patient outcomes and tailor perioperative management.
References
Modlin et al. 2008 -- Gastro-entero-pancreatic neuroendocrine tumors: epidemiology and biology
WHO Classification 2017 -- Tumor grading criteria for GEP-NEN
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