# Outcomes Following Surgery for Pancreatic Neuro-Endocrine Tumours: A Single-Centre Experience

## TL;DR

This study examines survival and recurrence after surgery for pancreatic neuroendocrine tumors, identifying factors that affect outcomes.

## Contribution

The study provides new insights into prognostic factors influencing survival and recurrence in patients with surgically resected pancreatic neuroendocrine tumors.

## Key findings

- PNETs show excellent long-term survival after curative surgery, with a 5-year overall survival rate of 83%.
- Larger tumor size, higher tumor grade, and lymph node metastases are linked to increased recurrence risk.
- Adverse pathological features like vascular invasion and perineural invasion are associated with poorer disease-free survival.

## Abstract

Aims: The purpose of this study was to evaluate survival outcomes and recurrence patterns following curative-intent resection of pancreatic neuroendocrine tumours (PNETs) at a UK tertiary centre. The secondary aims included identifying prognostic clinicopathological factors that influenced survival. Methods: Patients undergoing curative-intent surgical resection for PNETs between August 2010 and March 2024 were retrospectively reviewed. The data collated included demographics, histopathology, recurrence, and survival outcomes. Results: Eighty-six patients were included, with a median age of 61.5 years (IQR: 50–71) and an equal sex distribution. Most tumours were solitary (88.4%) and located in the pancreatic tail (57%), with distal pancreatectomy performed in 75% of cases. The median tumour size was 25 mm (IQR: 13–40). Lymph node metastases were observed in 23.3% of patients, and R0 resection was achieved in 67%. Most of the PNETs resected were WHO grade 1 tumours (65.1%), followed by grade 2 tumours (26.7%). Postoperative morbidity occurred in 37.2% of cases, while the 30-day postoperative mortality rate was 1.5%. Recurrence was observed in 13.95% of patients, with a median time to recurrence of 36.3 months. The 5-year overall survival (OS) was 83.0%, with a median OS and disease-free survival (DFS) of 143.3 months and 147.0 months, respectively. Multivariable analysis revealed that poorer DFS was associated with larger tumours (p = 0.009), higher tumour grade (p = 0.006), male sex (p = 0.039), vascular invasion (p = 0.003), perineural invasion (p = 0.042) and lymph node metastases (p = 0.015). OS was significantly influenced by the Charlson Comorbidity Index (p < 0.001) and tumour grade (p = 0.025). Conclusions: PNETs are associated with excellent long-term survival following curative-intent resection. However, adverse pathological features are linked to an increased risk of recurrence and a poorer prognosis.