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The Role of Primary Tumor Resection in Surgical Management of Asymptomatic Metastatic PNETs: A Retrospective
Vanja Podrascanin1,2, Markus Ammann1,2, Hallbera Gudmundsdottir1
1Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
Background:
Cytoreductive hepatectomy has repeatedly been reported to improve prognosis in pancreatic neuroendocrine tumor liver metastasis (PNETLM). However, whether primary tumor resection impacts prognosis in asymptomatic synchronously metastasized pancreatic neuroendocrine tumors (PNETs) remains elusive. We aimed to evaluate the prognostic impact of primary tumor resection in patients undergoing cytoreductive hepatectomy for PNETLM.
Patients And Methods:
This retrospective single-center study analyzed patients who underwent hepatectomy for pancreatic PNETLM between January 2000 and December 2020. Patients were categorized according to surgical approaches: cytoreductive hepatectomy without primary tumor resection at any time (non-PTR), cytoreductive hepatectomy and pancreaticoduodenectomy (PD), or cytoreductive hepatectomy and distal pancreatectomy (DP). Surgical outcomes and risk factors for overall survival (OS) were assessed.
Results:
A total of 118 patients with asymptomatic PNETs and synchronous liver metastases were analyzed. The median OS was 10 years (95% CI: 6.5-12), with no significant differences across surgical approach regarding primary tumor resection (non-PTR: 10 years; PD: 8 years; DP: 9.5 years; p = 0.589). Survival rates at 5 years were 66.7% in non-PTR, 62.3% in PD, and 65.8% in DP respectively. PFS was similar between groups (p = 0.301). Extrahepatic disease and liver lesion count were significant predictors of progression-free survival in univariate analysis (p < 0.050), while resection of the primary tumor had no significant impact (p = 0.749) CONCLUSIONS: PNET primary tumor resection was not associated with improved long-term outcomes in PNETLM patients after cytoreductive hepatectomy. This should spark interest if refraining from primary resection might be an option in selected patients considering the risks associated with pancreatic surgery.
