Endocrine Abstracts

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 (MM – 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 3,536 patients operated for entero-pancreatic NETs, 40.1% had pancreatic primary and 57.4% had metastases. Surgery occurred at median 2 months after diagnosis (IQR: 0-75). 90-day MM 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 (hepatectomy with enterectomy or pancreatectomy). 90-day mortality was 3.4% overall, with 4.0%, 1.7%, and 4.1% after hepatectomy, pancreatectomy, and enterectomy, respectively. Median LOS was 7 days (IQR: 5-10) overall, with 26.9% having prolonged LOS (>75^th percentile). 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 1.21-2.01) were independently associated with increased odds of 90-day MM. Median DAH-90 was 89 (IQR: 88-89) overall and did not differ by surgery type. Enterectomy (OR 0.98; 95%CI 0.97-0.99) and pancreatoduodenectomy (OR 0.98; 95%CI 0.96-0.99), increasing age (OR 0.97; 95%CI 0.97-0.98), and higher comorbidity (OR 0.95; 95%CI 0.92-0.98) were independently associated with fewer 90-DAH.

Conclusions: Approximately 1 out of 4 patients experienced 90d-MM after surgery for NETs and mortality below 5%, with increased risk for combined and pancreatoduodenectomy. Most patients spent the majority of 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.

Abstract ID #32943