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.
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)).
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.