Perioperative Risks of Concurrent Pancreatic and Hepatic Resections for Neuroendocrine Tumors
4 affiliations
- 1Department of Surgery University of Iowa Hospitals and Clinics Iowa City Iowa USA
- 2Department of Surgery University of Maryland Baltimore Maryland USA
- 3Carver College of Medicine University of Iowa Iowa City Iowa USA
- 4Department of Surgery Mayo Clinic Rochester Minnesota USA
Abstract
Background and Objectives: Pancreatic neuroendocrine tumors (pNETs) account for 1%–2% of pancreatic tumors, with an increasing incidence. The safety of concurrent pancreas‐liver resections remains uncertain. This study evaluated the national outcomes of concurrent pancreatectomy and liver‐directed surgery for pNETs.
Methods: ACS‐NSQIP (2019–2023) was queried for adult patients who underwent pancreatectomy for pNETs. Concurrent liver‐directed procedures were identified by CPT code and classified as hepatectomy or ablation alone; patients were grouped as isolated pancreatectomy, concurrent hepatectomy, or concurrent ablation alone. Pre‐, intra‐, and postoperative characteristics were compared using inferential statistics. Multivariable logistic regression identified predictors of 30‐day morbidity, readmission, reoperation, and mortality, with Firth penalized likelihood used for rare outcomes.
Results: Of 4794 patients, 4587 (95.7%) underwent isolated pancreatectomy, 172 (3.6%) underwent concurrent hepatectomy, and 35 (0.7%) underwent concurrent ablation alone. Concurrent hepatectomy was parenchymal‐sparing in 163 of 172 patients (94.8%); only nine patients underwent a major hepatectomy. Overall morbidity was similar across groups (38.8%, 45.9%, and 42.9%; p = 0.154), as was serious morbidity (28.7%, 27.9%, 22.9%; p = 0.730) and 30‐day mortality (1.0%, 0.6%, 0%). On multivariable analysis, neither concurrent hepatectomy (OR 1.02, 95% CI 0.71–1.48) nor concurrent ablation (OR 0.94, 95% CI 0.46–1.93) was associated with morbidity. Pancreatoduodenectomy was associated with morbidity (OR 2.38, 95% CI 2.05–2.76), reoperation (OR 2.16, 95% CI 1.52–3.08), and mortality (OR 2.50, 95% CI 1.39–4.50), and a minimally invasive approach was associated with lower morbidity (OR 0.69, 95% CI 0.60–0.80).
Conclusions: Concurrent liver‐directed surgery was not associated with an increase in 30‐day morbidity or mortality after pancreatectomy for pNETs. These findings support the safety of concurrent hepatic resection in appropriately selected pNET patients.
Related
- Intracranial metastasis following intrahepatic remission in primary hepatic small cell neuroendocrine carcinoma: a case report
- Primary Hepatic Neuroendocrine Neoplasms: Systematic Review and Expert Pathologist Reappraisal Using the WHO 6th Edition Framework
- Peripancreatic High-Grade Neuroendocrine Neoplasm Mimicking a Pancreatic Mass in Esophageal Small Cell Carcinoma
- Identifying tumor microenvironment subtypes in pancreatic neuroendocrine tumors using digital spatial profiling
- Hepatic Epithelioid Angiosarcoma with Abberrant Synaptophysin and CDX2 Expression Mimicking Neuroendocrine/Metastatic Carcinoma: A Fatal Case Report
BibTeX
@article{ebadinejad2026perioperative,
title = {{Perioperative Risks of Concurrent Pancreatic and Hepatic Resections for Neuroendocrine Tumors}},
author = {Amir Ebadinejad and Ashrita Raghuram and Sophia Xiao and Ethan Angle and Hassan Aziz},
journal = {Journal of Surgical Oncology},
year = {2026},
month = aug,
doi = {10.1002/jso.70352},
url = {https://doi.org/10.1002/jso.70352},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Perioperative Risks of Concurrent Pancreatic and Hepatic Resections for Neuroendocrine Tumors
AU - Amir Ebadinejad
AU - Ashrita Raghuram
AU - Sophia Xiao
AU - Ethan Angle
AU - Hassan Aziz
PY - 2026
DA - 2026/08/06
JO - Journal of Surgical Oncology
DO - 10.1002/jso.70352
UR - https://doi.org/10.1002/jso.70352
AB - Background and Objectives: Pancreatic neuroendocrine tumors (pNETs) account for 1%–2% of pancreatic tumors, with an increasing incidence. The safety of concurrent pancreas‐liver resections remains uncertain. This study evaluated the national outcomes of concurrent pancreatectomy and liver‐directed surgery for pNETs. Methods: ACS‐NSQIP (2019–2023) was queried for adult patients who underwent pancreatectomy for pNETs. Concurrent liver‐directed procedures were identified by CPT code and classified as hepatectomy or ablation alone; patients were grouped as isolated pancreatectomy, concurrent hepatectomy, or concurrent ablation alone. Pre‐, intra‐, and postoperative characteristics were compared using inferential statistics. Multivariable logistic regression identified predictors of 30‐day morbidity, readmission, reoperation, and mortality, with Firth penalized likelihood used for rare outcomes. Results: Of 4794 patients, 4587 (95.7%) underwent isolated pancreatectomy, 172 (3.6%) underwent concurrent hepatectomy, and 35 (0.7%) underwent concurrent ablation alone. Concurrent hepatectomy was parenchymal‐sparing in 163 of 172 patients (94.8%); only nine patients underwent a major hepatectomy. Overall morbidity was similar across groups (38.8%, 45.9%, and 42.9%; p = 0.154), as was serious morbidity (28.7%, 27.9%, 22.9%; p = 0.730) and 30‐day mortality (1.0%, 0.6%, 0%). On multivariable analysis, neither concurrent hepatectomy (OR 1.02, 95% CI 0.71–1.48) nor concurrent ablation (OR 0.94, 95% CI 0.46–1.93) was associated with morbidity. Pancreatoduodenectomy was associated with morbidity (OR 2.38, 95% CI 2.05–2.76), reoperation (OR 2.16, 95% CI 1.52–3.08), and mortality (OR 2.50, 95% CI 1.39–4.50), and a minimally invasive approach was associated with lower morbidity (OR 0.69, 95% CI 0.60–0.80). Conclusions: Concurrent liver‐directed surgery was not associated with an increase in 30‐day morbidity or mortality after pancreatectomy for pNETs. These findings support the safety of concurrent hepatic resection in appropriately selected pNET patients.
SN - 0022-4790
SN - 1096-9098
ER -