Complications After Major Surgery for Duodenopancreatic Neuroendocrine Tumors in Patients with MEN1: Results from a Nationwide Cohort

Dirk Jan van Beek, the DutchMEN Study Group (DMSG), Casper H.J. van Eijck

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11 Citations (Scopus)


Background: Little is known about complications after major duodenopancreatic surgery for duodenopancreatic neuroendocrine tumors (dpNETs) in multiple endocrine neoplasia type 1 (MEN1). Therefore, the incidence and severity of complications after major surgery for MEN1-related dpNETs were assessed. Methods: Patients were selected from the population-based Dutch MEN1 database if they had undergone a Whipple procedure or total pancreatectomy from 2003 to 2017. Complications were graded according to the Clavien–Dindo classification (grade III or higher complications were considered a severe complication) and definitions from the International Study Group of Pancreatic Surgery. The Cumulative Complication Index (CCI®) was calculated as the sum of all complications weighted for their severity. Univariable logistic regression was performed to assess potential associations between predictor candidates and a severe complication. Results: Twenty-seven patients (median age 43 years) underwent a major duodenopancreatic resection, including 14 Whipple procedures and 13 total pancreatectomies. Morbidity and mortality were 100% (27/27) and 4% (1/27), respectively. A severe complication occurred in 17/27 (63%) patients. The median CCI® was 47.8 [range 8.7–100]. Grade B/C pancreatic fistulas, delayed gastric emptying, bile leakage, hemorrhage, and chyle leakage occurred in 7/14 (50%), 10/27 (37%), 1/27 (4%), 7/27 (26%), 3/27 (11%) patients, respectively. Patients with a severe complication had longer operative time and higher blood loss. After Whipple, new-onset endocrine and exocrine insufficiency occurred in 1/13 and 9/14 patients, respectively. Conclusions: Major duodenopancreatic surgery in MEN1 is associated with a very high risk of severe complications and cumulative burden of complications and should therefore be reserved for a select subgroup of patients with MEN1-related dpNETs.

Original languageEnglish
Pages (from-to)4387-4399
Number of pages13
JournalAnnals of Surgical Oncology
Issue number8
Publication statusPublished - 31 Jan 2021

Bibliographical note

Funding Information:
The authors would like to thank the additional DMSG members for their contributions (listed in alphabetical order): P.H. Bisschop, MD, PhD, Department of Endocrinology and Metabolism, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands. O.M. Dekkers, MD, PhD, Departments of Endocrinology and Metabolism and Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands. M.L. Drent, MD, PhD, Department of Internal Medicine, Section of Endocrinology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands. B. Havekes, MD, PhD, Department of Internal Medicine, Division of Endocrinology, Maastricht University Medical Center, Maastricht, The Netherlands. W.W. de Herder, MD, PhD, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands. A.N.A. van der Horst-Schrivers, MD, PhD, Department of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands. C.R.C. Pieterman, MD, PhD, Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, The Netherlands. A.C. van de Ven, MD, PhD, Department of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands.

Publisher Copyright:
© 2021, The Author(s).


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