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Perioperative Risks of Concurrent Pancreatic and Hepatic Resections for Neuroendocrine Tumors
Journal article   Open access   Peer reviewed

Perioperative Risks of Concurrent Pancreatic and Hepatic Resections for Neuroendocrine Tumors

Amir Ebadinejad, Ashrita Raghuram, Sophia Xiao, Ethan Angle and Hassan Aziz
Journal of surgical oncology
08/06/2026
DOI: 10.1002/jso.70352
PMID: 42558023
Appears in  UI Libraries Support Open Access
url
https://doi.org/10.1002/jso.70352View
Published (Version of record) Open Access

Abstract

Pancreatic neuroendocrine tumors (pNETs) account for 1%-2% of pancreatic tumors, with an increasing incidence. The safety of concurrent pancreas-liver resections remains uncertain. This study evaluated the national outcomes of concurrent pancreatectomy and liver-directed surgery for pNETs. ACS-NSQIP (2019-2023) was queried for adult patients who underwent pancreatectomy for pNETs. Concurrent liver-directed procedures were identified by CPT code and classified as hepatectomy or ablation alone; patients were grouped as isolated pancreatectomy, concurrent hepatectomy, or concurrent ablation alone. Pre-, intra-, and postoperative characteristics were compared using inferential statistics. Multivariable logistic regression identified predictors of 30-day morbidity, readmission, reoperation, and mortality, with Firth penalized likelihood used for rare outcomes. Of 4794 patients, 4587 (95.7%) underwent isolated pancreatectomy, 172 (3.6%) underwent concurrent hepatectomy, and 35 (0.7%) underwent concurrent ablation alone. Concurrent hepatectomy was parenchymal-sparing in 163 of 172 patients (94.8%); only nine patients underwent a major hepatectomy. Overall morbidity was similar across groups (38.8%, 45.9%, and 42.9%; p = 0.154), as was serious morbidity (28.7%, 27.9%, 22.9%; p = 0.730) and 30-day mortality (1.0%, 0.6%, 0%). On multivariable analysis, neither concurrent hepatectomy (OR 1.02, 95% CI 0.71-1.48) nor concurrent ablation (OR 0.94, 95% CI 0.46-1.93) was associated with morbidity. Pancreatoduodenectomy was associated with morbidity (OR 2.38, 95% CI 2.05-2.76), reoperation (OR 2.16, 95% CI 1.52-3.08), and mortality (OR 2.50, 95% CI 1.39-4.50), and a minimally invasive approach was associated with lower morbidity (OR 0.69, 95% CI 0.60-0.80). Concurrent liver-directed surgery was not associated with an increase in 30-day morbidity or mortality after pancreatectomy for pNETs. These findings support the safety of concurrent hepatic resection in appropriately selected pNET patients.
 hepatectomy neuroendocrine tumor short‐term outcomes ACS‐NSQIP pancreatectomy UIOWA OA Agreement

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