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Publications

Journal Article Epublish

PubMed: 42795808 DOI: 10.3390/jcm15187035

Functional Status and Postoperative Outcomes After Left Pancreatectomy for Pancreatic Neuroendocrine Tumors: An Exploratory Analysis from the Prospective SPANDISPAN Study.

J Clin Med 15(18)

Authors: José Manuel Ramia, Belén Hernández-Roca, Juan Jesús Rubio-García, Daniel Aparicio-López, Juli Busquets, Luis Secanella, Nuria Peláez, Maialen Alkorta, Itziar de Ariño-Hervás, María Del Mar Achalandabaso, Enrique Toledo, Fernando Rotellar, Pablo Martí-Cruchaga, Miguel Ángel Gómez-Bravo, Gonzalo Suárez, Marina Garcés-Albir, Luis Sabater, Gabriel García, Francisco Javier Alcalá, Enrique Asensio, David Pacheco, Esteban Cugat, Francisco Espín, María Galófre, Belinda Sánchez, Julio Santoyo, Jorge Calvo, Carmelo Loinaz, María Isabel García-Domingo, Santiago Sánchez-Cabús, Belén Martín, Gerardo Blanco-Fernández, Isabel Jaén-Torrejimeno, Carlos Domingo, Carmen Payá, Carmen González, Sandra Ruiz, Rafael López-Andújar, Cristina Ballester, Ana Belén Vico, Natalia Zambudio, Sergio Estévez, Manuel Nogueira-Sixto, José Ignacio Miota, Belén Conde, Miguel Ángel Suárez, Jorge Roldán de la Rúa, Angélica Blanco, Manuel González, Pilar Elena González … and 29 other authors

Affiliations

  • Department of Surgery, General University Hospital Dr. Balmis, 03010 Alicante, Spain.
  • Institute of Health and Biomedical Research of Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain.
  • Department of Surgery, School of Medicine, Miguel Hernández University, 03202 Alicante, Spain.
  • Department of Surgery, Hospital General Universitario de Elda, 03600 Alicante, Spain.
  • Department of Surgery, Hospital Ernest Lluch, 50300 Calatayud, Spain.
  • Department of Surgery, Hospital Universitario Bellvitge, 08907 L'Hospitalet de Llobregat, Spain.
  • Department of Surgery, Hospital Universitario de Donostia, 20014 San Sebastián, Spain.
  • Department of Surgery, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain.
  • Department of Surgery, Clínica Universidad de Navarra, 31008 Pamplona, Spain.
  • Department of Surgery, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain.
  • Liver-Biliary and Pancreatic Unit, Department of General and Digestive Surgery, Hospital Clinico Universitario, Biomedical Research Institute, INCLIVA, 46010 Valencia, Spain.
  • Department of Surgery, Hospital Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain.
  • Department of Surgery, Hospital Universitario Rio Ortega, 47012 Valladolid, Spain.
  • Department of Surgery, Hospital Universitario German Trias i Pujol, 08916 Badalona, Spain.
  • Department of Surgery, Hospital Regional Universitario Carlos Haya, 29010 Málaga, Spain.
  • Department of Surgery, Hospital Universitario Doce de Octubre, 28041 Madrid, Spain.
  • Department of Surgery, Hospital Universitario Mutua de Terrassa, 08221 Terrassa, Spain.
  • Department of Surgery, Hospital Universitario Santa Creu i Sant Pau, 08025 Barcelona, Spain.
  • Department of Surgery, Hospital Universitario de Badajoz, 06080 Badajoz, Spain.
  • Department of Surgery, Hospital Universitario Doctor Peset, 56017 Valencia, Spain.
  • Department of Surgery, Hospital Universitario de Basurto, 48013 Bilbao, Spain.
  • Surgery HPB and Liver Transplant Unit, Instituto de Investigación Sanitaria La Fe (IIS La Fe) & CIBEREHD, Universitary and Politecnic Hospital La Fe, 46026 Valencia, Spain.
  • Department of Surgery, Hospital Universitario Virgen de las Nieves, 18012 Granada, Spain.
  • Department of Surgery, Complejo Hospitalario Universitario de Vigo, 36312 Vigo, Spain.
  • Department of Surgery, Hospital General Universitario de Albacete, 02008 Albacete, Spain.
  • Department of Surgery, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain.
  • Department of Surgery, Complejo Hospitalario Universitario Juan Canalejo, 15006 A Coruña, Spain.
  • Department of Surgery, Hospital Universitario Nuestra Sra. de la Candelaria, 38010 Tenerife, Spain.

Abstract

Background: Whether tumor functional status influences postoperative outcomes after left pancreatectomy (LP) for pancreatic neuroendocrine tumors (pNETs) remains unknown. We evaluated the association between functional status, perioperative management, and postoperative outcomes in a prospective nationwide cohort of patients undergoing LP for pNET. Methods: This prespecified analysis of the prospective multicenter SPANDISPAN study included consecutive patients undergoing elective LP at 41 Spanish hospitals between February 2022 and January 2023. Of 98 patients with pNET, functional status was available in 88 (14 functioning and 74 non-functioning tumors). Perioperative characteristics, spleen preservation, and postoperative outcomes were compared according to tumor functional status. Results: Spleen preservation was performed in 28.6% of functioning and 18.9% of non-functioning tumors (p = 0.472; risk difference 9.7 percentage points, 95% CI [confidence interval] -15.6 to 34.9). Patients with functioning tumors had lower rates of clinically relevant postoperative pancreatic fistula (7.1% vs. 36.5%; p = 0.032; risk difference -29.3 percentage points, 95% CI -46.7 to -12.0), shorter length of hospital stay (median 4 vs. 7 days; p = 0.036), and no 90-day readmissions (0% vs. 31.1%; p = 0.017; risk difference -31.1 percentage points, 95% CI -41.6 to -20.5). Tumor functional status was not significantly associated with the use of spleen-preserving resection. Conclusions: Functional status is associated with clinically relevant differences in postoperative outcomes after LP for pNET. Patients with functioning tumors experienced lower postoperative morbidity than those with non-functioning tumors, whereas no statistically significant association was detected between tumor functional status and spleen preservation. These exploratory findings suggest that tumor functional status may warrant consideration as an additional factor in perioperative risk stratification and patient counseling, pending confirmation in larger, adequately powered studies; spleen preservation should continue to be guided by established oncological criteria.

MeSH

Neoplasms, Pancreas, Neuroendocrine Tumors, Neuroectodermal Tumors, Primitive, Spleen, Pancreatectomy, Functional Status