Contemporary short-term post-operative outcomes after resection of entero-pancreatic NETs: a population-based study

Background — Surgery is a cornerstone of management for neuroendocrine tumors (NETs), but outcomes vary. It is critical to understand the real-world morbidity profile of surgery to optimize patient selection and outcomes. We examined short-term outcomes after resection for entero-pancreatic NETs.

Methods — We performed a population-based retrospective cohort study of adults with entero-pancreatic NETs (2000-2023). The outcome was 90-day major morbidity (Clavien-Dindo 3-5) and 90-day days-at-home after surgery (90-DAH). Logistic regression examined factors associated with outcomes for each type of surgery.

Results — Of 3699 surgeries for entero-pancreatic NETs, 30.5% involved a pancreatic primary, and 58.6% had metastases. 90-day major morbidity was 24.4% after all surgeries, including 26.9% after hepatectomy, 30.3% after pancreatectomy, 21.3% after enterectomy, and 30.4% after combined resection. 90-day mortality was 3.4% overall, with 4.0%, 1.7%, and 4.1% after hepatectomy, pancreatectomy, and enterectomy, respectively. Combined resection (OR 1.44; 95%CI 1.08-1.94) and pancreatoduodenectomy (OR 2.35; 95%CI 1.77-3.12), as well as age (OR 1.21; 95%CI 1.14-1.29) and higher comorbidity burden (OR 1.56; 95%CI 1.20-2.01) were independently associated with increased odds of 90-day major morbidity. Median DAH-90 was 82 (IQR: 77-84) overall and did not differ by surgery type. Combined hepatectomy, pancreatoduodenectomy, and higher comorbidity were independently associated with fewer 90-DAH.

Conclusion — Approximately 1 out of 4 patients experienced 90-day major morbidity after surgery for NETs and mortality below 5%. Most patients spent most of the time at home after surgery for NETs. This information is important to counsel patients, inform discussions about treatment options, and set expectations for post-operative recovery.