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Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons
Pancreatic Neuroendocrine Tumors: A National Survey

Edward Arous, BS, Theodore P. Mc Dade, MD, Joshua S. Hill, MD, Giles F. Whalen, MD, Jennifer F. Tseng, MD, MPH, University of Massachusetts
Medical School- Surgical Outcomes & Analysis Research; Worcester, MA


PURPOSE OF STUDY
Pancreatic neuroendocrine tumors (PNETs) have a prolonged natural history, and the benefit of resection remains controversial. Accordingly, treatment approaches are not standardized. We assessed surgical resection of PNETs on a national level.

METHODS USED:
Our retrospective observational study utilized the Nationwide Inpatient Sample (1998-2006). Outcome measures included in-hospital mortality and length of stay (LOS). Univariate analyses included Chi-square and Cochran-Armitage Trend tests. Multivariable logistic regression was used to evaluate predictors of outcomes.

SUMMARY OF RESULTS:
3306 unweighted observations for patient admissions for PNETs were identified. Overall, 470 patients (14.2%) underwent resection, including distal pancreatectomy (56.4%) and pancreaticoduodenectomy (24.5%). Over the study period, the proportion receiving resection increased (p=0.0026). Predictors of resection on multivariable analysis included age <70 (vs. >70; adjusted odds ratio (OR) 1.7 (95% confidence interval (CI) 1.3-2.3)) and hospital teaching status (vs. non-teaching; OR 2.3 (CI 1.7-3.2)). Mean LOS for patients undergoing resection was 12.3 versus 6.6 days for non-resection admissions (p<0.0001). On univariate analysis, the in-hospital mortality rate for resected patients was 1.7% versus 5.2% for the nonresected group (p=0.0009). Nonresection remained a significant predictor of in-hospital mortality by logistic regression (vs. resection; OR 3.9 (CI 2.0-7.7)), as were age >70 (vs. <70; OR 2.2 (CI 1.6-3.1)) and length-of-stay >14 days (vs. <2 weeks; OR 3.7 (CI 2.5-5.5)).

CONCLUSIONS:
More resections for PNETs are being performed over time. In-hospital mortality is higher for the non-resected group, suggesting disease-related factors. Perioperative mortality for patients undergoing resection is acceptably low, supporting the role of aggressive treatment for PNETs.

 

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