Short-term surgical outcomes for patients with non-functional pancreatic neuroendocrine tumors are unaffected by chronological age

TL;DR

Surgical outcomes for non-functional pancreatic tumors are similar in older and younger patients, despite older adults having more health issues.

Contribution

This study shows chronological age does not worsen surgical outcomes for non-functional pancreatic tumors.

Findings

Older patients had more cardiac and pulmonary conditions but similar surgical outcomes to younger patients.

Postoperative complications and 30-day mortality were not significantly different between age groups.

Tumor characteristics like stage and Ki-67 index were comparable across age groups.

Abstract

Non-functional pancreatic neuroendocrine tumors (NF-pNETs) are increasingly diagnosed, particularly in older adults, largely due to widespread cross-sectional imaging. Patients with NF-pNETs typically have a soft pancreas and a small main pancreatic duct, which puts them at high risk for postoperative pancreatic fistula B/C, significantly impacting postoperative morbidity and mortality. Given the rising incidence of NF-pNETs and ongoing uncertainty about optimal treatment in older individuals, this study evaluates postoperative outcomes and histopathological differences between older and younger patient cohorts.

In this study, a total of 171 patients that underwent any type of pancreatic resection for NF-pNETs between 2003 and 2023 at our institution, were investigated retrospectively upon demographic data, postoperative complications, duration of hospital stay and tumor histology. Patients were stratified into younger (< 70 years) and older (> 70 years) groups. Postoperative short-term outcomes were compared between both groups.

A total of 171 patients underwent pancreatic resection for NF-pNETs, including 129 younger (<70 years) and 42 older (≥70 years) patients. Older patients exhibited a markedly higher prevalence of cardiac (62% vs. 30%) and pulmonary conditions (15% vs. 5%) compared to their younger counterparts. Surgical approaches and tumor locations were similar. Postoperative outcomes, including POPF, PPH, DGE, LOS, and 30-day mortality, did not significantly differ between groups. Ideal outcome (IO) was achieved in 45.5% of younger and 37.2% of older patients (p = NS). Oncological features such as tumor stage, lymph node involvement, grading, and Ki-67 index were comparable.

Surgical resection for NF-pNETs appears to be a safe option in older patients (≥70 years), as chronological age by itself does not significantly impact postoperative outcomes.

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