Ideal outcomes in pancreatic neuroendocrine tumor vs. adenocarcinoma following resection: A nationwide study using ACS-NSQIP

IF 2.9 2区医学 Q2 ONCOLOGY

Ejso Pub Date : 2025-09-08 DOI:10.1016/j.ejso.2025.110438

Jiage Qian , Sebastiaan Ceuppens , Nikhil V. Tirukkovalur , Kenneth K. Lee , Amer H. Zureikat , Alessandro Paniccia

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引用次数: 0

Abstract

Background

Prior evidence suggests higher postoperative complications in pancreatic neuroendocrine tumors (pNET) compared to ductal adenocarcinoma (PDAC). This study refines the comparison using the Ideal Outcome (IO) metric and identifies predictors of IO.

Methods

A retrospective cohort study was performed using the 2014–2023 standard and pancreas-targeted ACS-NSQIP database to identify patients with PDAC or pNET who underwent pancreatoduodenectomy (PD) or distal pancreatectomy (DP). IO was defined as absence of clinically relevant postoperative pancreatic fistula (CR-POPF), prolonged length of stay (LOS), severe complications, reoperation, readmission, and mortality.

Results

A total of 25,290 PDAC and 4914 pNET patients were included. In PD, IO was lower in pNET (44.2 %) compared to PDAC (56.9 %, p < 0.001), with pNET having higher rates of severe complications (31.2 % vs. 19.0 %, p < 0.001), prolonged LOS (28.9 % vs. 25.8 %; p = 0.004), CR-POPF (26.7 % vs. 10.9 %; p < 0.001), and readmission (23.6 % vs. 15.3 %; p < 0.001). In contrast, pNET had higher IO after DP (60.1 % vs. 57.1 %; p = 0.008), with higher CR-POPF (19.2 % vs. 13.4 %; p < 0.001) but lower prolonged LOS (18.5 % vs. 26.4 %; p < 0.001). In PD, predictors of lower IO for both histologies included male sex (PDAC aOR 0.83; pNET 0.60), obesity (0.77; 0.63), hypertension (0.89; 0.79), small duct (0.81; 0.75), and soft gland (0.62; 0.57). In DP, minimally invasive surgery was associated with higher IO in both cancer types (PDAC aOR 1.71; pNET 1.52; all p < 0.05).

Conclusion

Compared to PDAC, IO rate for pNET was lower after PD but higher after DP. CR-POPF was consistently higher in pNET, while other components of IO varied by procedure.

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胰腺神经内分泌肿瘤与腺癌切除术后的理想预后：一项使用ACS-NSQIP的全国性研究

背景先前的证据表明胰腺神经内分泌肿瘤（pNET）的术后并发症比导管腺癌（PDAC）高。本研究使用理想结果（IO）指标改进了比较，并确定了IO的预测因素。方法采用2014-2023年标准和以胰腺为目标的ACS-NSQIP数据库，对行胰十二指肠切除术（PD）或远端胰腺切除术（DP）的PDAC或pNET患者进行回顾性队列研究。IO定义为无临床相关的术后胰瘘（CR-POPF）、住院时间延长（LOS）、严重并发症、再手术、再入院和死亡率。结果共纳入PDAC患者25290例，pNET患者4914例。在PD中，pNET的IO（44.2%）低于PDAC (56.9%, p < 0.001)， pNET有更高的严重并发症发生率（31.2%比19.0%,p < 0.001），延长LOS(28.9%比25.8%,p = 0.004), CR-POPF（26.7%比10.9%,p < 0.001）和再入院（23.6%比15.3%,p < 0.001）。相比之下，pNET在DP后具有较高的IO(60.1%对57.1%,p = 0.008)，具有较高的CR-POPF(19.2%对13.4%,p < 0.001)，但较低的延长LOS（18.5%对26.4%,p < 0.001）。在PD中，两种组织学的低IO预测因子包括男性（PDAC aOR 0.83; pNET 0.60）、肥胖（0.77;0.63）、高血压（0.89;0.79）、小导管（0.81;0.75）和软腺（0.62;0.57）。在DP中，两种癌症类型的微创手术均与较高的IO相关（PDAC aOR 1.71; pNET 1.52；均p <； 0.05）。结论与PDAC相比，PD后pNET的IO率较低，DP后pNET的IO率较高。CR-POPF在pNET中始终较高，而IO的其他组成部分因程序而异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Ejso 医学-外科

CiteScore

6.40

自引率

2.60%

发文量

1148

审稿时长

41 days

期刊介绍： JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery. The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.