Pancreatic insufficiency following pancreatectomy: Does underlying tumor syndrome confer a greater risk?

Am J Surg. 2021 Feb;221(2):465-471. doi: 10.1016/j.amjsurg.2020.08.048. Epub 2020 Sep 5.

Abstract

Background: The risk of postoperative pancreatic exocrine insufficiency (PPEI) is unknown in patients with multiple endocrine neoplasia type I (MEN1) and von Hippel-Lindau (VHL) who require resection of pancreatic neuroendocrine tumors (PNETs).

Methods: A retrospective review of patients who underwent resection of PNETs at the National Institutes of Health from 2007 to 2019 was performed.

Results: Our cohort included 82 patients (VHL n = 25, MEN1 n = 20, sporadic n = 37), 6 of whom developed PPEI. While VHL compared to all non-VHL patients (p = 0.046), non-functional PNETs (p = 0.050), and pancreaticoduodenectomy (PD) (p=<0.001) were associated with higher rates of PPEI on univariate analysis, only PD was found to be an independent predictor of PPEI on multivariate analysis (OR 14.43, 95% CI 1.43-145.8, p = 0.024).

Conclusions: The rate of PPEI in patients with hereditary tumor syndromes was similar to that of sporadic PNETs. PD was independently associated with PPEI, and this increased risk should be included in preoperative counseling.

Keywords: MEN-1; Pancreatectomy; Pancreatic insufficiency; VHL.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Intramural

MeSH terms

  • Adult
  • Exocrine Pancreatic Insufficiency / epidemiology*
  • Exocrine Pancreatic Insufficiency / etiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multiple Endocrine Neoplasia Type 1 / complications
  • Multiple Endocrine Neoplasia Type 1 / diagnosis
  • Multiple Endocrine Neoplasia Type 1 / surgery
  • Neuroendocrine Tumors / etiology
  • Neuroendocrine Tumors / surgery*
  • Pancreatectomy / adverse effects*
  • Pancreatectomy / statistics & numerical data
  • Pancreatic Neoplasms / etiology
  • Pancreatic Neoplasms / surgery*
  • Pancreaticoduodenectomy / adverse effects*
  • Pancreaticoduodenectomy / statistics & numerical data
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Prospective Studies
  • Retrospective Studies
  • von Hippel-Lindau Disease / complications
  • von Hippel-Lindau Disease / diagnosis
  • von Hippel-Lindau Disease / surgery

Supplementary concepts

  • Non functioning pancreatic endocrine tumor