Minimally invasive versus open surgery for nonfunctioning pancreatic neuroendocrine tumors: a systematic review and meta-analysis.

in International journal of surgery (London, England) by Kongyuan Wei, Qingyong Zheng, Luying Cheng, Wei Li, Anna Nießen, Faik G Uzunoglu, Felix Nickel, Jinhui Tian, Zheng Wang, Thilo Hackert

TLDR

  • This study compared the outcomes of minimally invasive surgery (MIS) and open surgery (OPS) for nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs) and found that MIS resulted in less intraoperative blood loss and shorter hospital stay, but with no significant differences in operative time or complications.

Abstract

Nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs) have been diagnosed increasingly often but still represent rare pancreatic neoplasms. Surgery is a potentially curative approach for patients with NF-PNETs. In recent years, minimally invasive surgery (MIS) has been applied more frequently for surgical resection of NF-PNETs. The evidence for using MIS for NF-PNETs is still being determined and controversial. PubMed, Cochrane Library, and the Web of Science database were searched systematically from its inception to July 2023. All studies comparing MIS versus open surgery (OPS) of NF-PNETs were included. The primary outcomes were the incidence of overall postoperative complications and pancreas-specific complications [postoperative pancreatic fistula (POPF) and delayed gastric emptying (DGE)]. The secondary measures were duration of operation, intraoperative blood loss, and length of postoperative hospital stay. Pooled results are presented as odds ratios (OR) or mean difference (MD) with a 95% CI. Five observational studies with a total of 1178 patients were included in the final analysis. The meta-analysis indicated that MIS attained less intraoperative blood loss (MD=-58.59, 95% CI [-92.76 to -24.41], P<0.01) and shorter length of hospital stay (MD=-3.07, 95% CI [-5.28 to -0.87], P<0.01) in contrast to open surgery for NF-PNETs. There were no significant differences concerning operative time (MD=52.04, 95% CI [-8.74 to 112.81], P=0.67), overall postoperative complications (OR=0.78, 95% CI [0.59-1.03], P=0.08), POPF (OR=0.99, 95% CI [0.66-1.47], P=0.94), and DGE (OR=0.58, 95% CI [0.58-1.42], P=0.67). This study demonstrates that minimally invasive surgery for NF-PNETs is safe and associated with a considerably shorter postoperative hospital stay. Further studies are needed to verify the evidence.

Overview

  • The study aims to compare the outcomes of minimally invasive surgery (MIS) and open surgery (OPS) for nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs).
  • The primary outcomes were the incidence of overall postoperative complications, pancreas-specific complications, duration of operation, intraoperative blood loss, and length of postoperative hospital stay.
  • The study included five observational studies with a total of 1178 patients and aimed to determine the evidence for using MIS for NF-PNETs.

Comparative Analysis & Findings

  • The meta-analysis showed that MIS resulted in less intraoperative blood loss (MD=-58.59, 95% CI [-92.76 to -24.41], P<0.01) and shorter length of hospital stay (MD=-3.07, 95% CI [-5.28 to -0.87], P<0.01) compared to open surgery.
  • There were no significant differences in operative time, overall postoperative complications, pancreas-specific complications (postoperative pancreatic fistula and delayed gastric emptying), and length of hospital stay between the two surgical approaches.
  • The study demonstrates that MIS for NF-PNETs is safe and associated with a considerably shorter postoperative hospital stay.

Implications and Future Directions

  • The findings of this study suggest that MIS could be considered as a suitable approach for patients with NF-PNETs, especially given the potential benefits of shorter hospital stay.
  • However, further studies are needed to verify the evidence and address the limitations of this study, including the inclusion of observational studies and the lack of randomized controlled trials.
  • Future studies could explore the long-term outcomes of patients who underwent MIS for NF-PNETs and investigate the cost-effectiveness of this approach compared to OPS.
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