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Patient characteristics and clinical outcomes following initial surgical intervention for MEN1 associated pancreatic neuroendocrine tumours: A systematic review and exploratory meta-analysis of the literature

Lookup NU author(s): Professor Sanjay PandanaboyanaORCiD

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Abstract

© 2019 IAP and EPCBackground: This systematic review aimed to define the outcomes of different pancreatic resection procedures for multiple endocrine neoplasia type 1 (MEN1) associated pancreatic neuroendocrine neoplasms (pNENs). Methods: A search of PubMed, MEDLINE and SCOPUS databases were performed in accordance with PRISMA guidelines. Results: Twenty-seven studies including 533 patients undergoing initial pancreatic resection for MEN1 associated pNENs were included in this systematic review. Three hundred and sixty-six (68.7%) distal pancreatectomies (DP), 120 (22.5%) sole enucleations (SE) and 47 (8.8%) pancreaticoduodenectomies (PD) were identified. SE was associated with a higher rate of recurrence than DP (25/67, 37% vs 40/190, 21% respectively, P = 0.008) but a lower rate of endocrine insufficiency than PD (1/20, 5% vs 8/21, 38% respectively, P = 0.010). A meta-analysis of major pancreatic resections (PD or DP) vs SE in 15 studies showed that SE is associated with an increased rate of recurrence (Major resection 42/184, 23% vs SE 20/53, 38% RR 0.65 CI 0.43–0.96 P = 0.032) but reduced rate of postoperative endocrine insufficiency (Resection 37/93, 40% vs SE 0/24, 0% RR 7.37 CI 1.57–34.64 P = 0.008). Similarly, insulinomas and functional pNENs overall had lower rates of recurrence and reoperation with major resection. There was no difference in the reoperation rates or survival outcomes after SE compared with major pancreatic resections at follow-up (pooled overall mean duration: 85 months). Conclusion: Major pancreatic resections for MEN1 associated pNENs have a lower risk of recurrence and a higher risk of postoperative endocrine insufficiency when compared to sole enucleation, but a similar rate of reoperation and survival.

Publication metadata

Author(s): Ratnayake CBB, Loveday BP, Windsor JA, Lawrence B, Pandanaboyana S

Publication type: Review

Publication status: Published

Journal: Pancreatology

Year: 2019

Volume: 19

Issue: 3

Pages: 462-471

Print publication date: 01/04/2019

Online publication date: 12/03/2019

Acceptance date: 07/03/2019

ISSN (print): 1424-3903

ISSN (electronic): 1424-3911

Publisher: Elsevier B.V.

URL: https://doi.org/10.1016/j.pan.2019.03.002

DOI: 10.1016/j.pan.2019.03.002

PubMed id: 30894303

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