Pancreaticoduodenectomy for pancreatic neuroendocrine neoplasms: incidence, risk and predictors of postoperative morbidity and mortality

Background: Pancreaticoduodenectomy (PD) is associated with a high risk of post-operative complications and mortality. Aim of this study was to compare morbidity after PD in patients undergoing resections for pancreatic neuroendocrine neoplasms (PanNENs) with patients with pancreatic ductal adenocarcinoma (PDAC). Methods: Data collected of 566 patients from three European tertiary referral centres between January 1998 and December 2014 were considered for analysis. Clinical and operative details were recorded. Univariate and multivariate analyses were performed. Results: Overall, 566 patients (179 with PanNENs and 387 with PDAC) who underwent PD were analysed. The consistence of the pancreas was soft in 147 (82%) patients with PanNENs and in 162 (42%) patients with PDAC (P<0.0001). Patients in the PNENs groups had a significantly higher rate of pancreatic fistula (PF)(33.5% versus 19%,P<0.0001), bile leak (9.5% versus 4%, P=0.004), abdominal collection (21% versus 13%, P=0.017), and development of sepsis (15% versus 9%, P=0.042). No differences in terms of in-hospital mortality (2%). On multivariate analysis gender (male), PanNENs indication, blood transfusion and “soft” pancreas were independent predictors of PF after PD. Conclusion: In this large series, the presence of a “soft” pancreas is the major determinant of the risk of postoperative morbidity among these patients. The association between PanNEN diagnosis and a “soft” pancreatic texture justifies the high risk of clinically relevant PF among these patients.