Early and Late Complications After Surgery for MEN1-related Nonfunctioning Pancreatic Neuroendocrine Tumors.
To estimate short and long-term morbidity after pancreatic surgery for multiple endocrine neoplasia type 1 (MEN1)-related nonfunctioning pancreatic neuroendocrine tumors (NF-pNETs).



Fifty percent of the MEN1 patients harbor multiple NF-pNETs. The decision to proceed to NF-pNET surgery is a balance between the risk of disease progression versus the risk of surgery-related morbidity. Currently, there are insufficient data on the surgical complications after MEN1 NF-pNET surgery.



MEN1 patients diagnosed with a NF-pNET who underwent surgery were selected from the DutchMEN1 study group database, including >90% of the Dutch MEN1 population. Early postoperative complications, new-onset diabetes mellitus, and exocrine pancreatic insufficiency were captured.



Sixty-one patients underwent NF-pNET surgery at 1 of the 8 Dutch academic centers. Patients were young (median age 41 years) with low American Society of Anesthesiologists scores. Median NF-pNET size on imaging was 22 mm (3-157). Thirty-three percent (19/58) of the patients developed major early-Clavien-Dindo grade III to IV-complications mainly consisting International Study Group of Pancreatic Surgery grade B/C pancreatic fistulas. Twenty-three percent of the patients (14/61) developed endocrine or exocrine pancreas insufficiency. The development of major early postoperative complications was independent of the NF-pNET tumor size. Twenty-one percent of the patients (12/58) developed multiple major early complications.



MEN1 NF-pNET surgery is associated with high rates of major short and long-term complications. Current findings should be taken into account in the shared decision-making process when MEN1 NF-pNET surgery is considered.
Department of Endocrine Surgical Oncology and Endocrine Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
Sjoerd
S
Nell
Department of Surgical Oncology and Endocrine Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
Inne H M
IHM
Borel Rinkes
Imaging Division, University Medical Center Utrecht, Utrecht, the Netherlands.
Helena M
HM
Verkooijen
Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
Bert A
BA
Bonsing
Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
Casper H
CH
van Eijck
Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
Harry
H
van Goor
Department of Hepato-Pancreatico-Biliary and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Ruben H J
RHJ
de Kleine
Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands.
Geert
G
Kazemier
Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
Elisabeth J
EJ
Nieveen van Dijkum
Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
Cornelis H C
CHC
Dejong
Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
Gerlof D
GD
Valk
Department of Endocrine Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
Menno R
MR
Vriens
D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018761:Multiple Endocrine Neoplasia Type 1 / Q000601:surgery*; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies