Outcome after pancreatectomy for neuroendocrine neoplams according to the WHO 2017 grading system: A retrospective multicentric analysis of 138 consecutive patients.

AIM: The aim of this study was to evaluate the new World Health Organization (WHO) 2017 grading system and the others clinicopathological factors in pancreatic neuroendocrine tumor (panNET) operated patients. METHODS: Histological staging was based on the WHO 2017 grading system. Outcome after surgery and predictors of overall survival (OS) and disease free survival (DFS) were evaluated. RESULTS: A total of 138 patients underwent surgical resection with a severe morbidity and mortality rates of 14.5% and 0.7% respectively. Five years OS differed according to WHO 2017: 95% among 58 patients with NETG1, 82% in 68 patients with NETG2, 35% in 7 patients with NETG3 and 0% in 5 patients with NECG3 (P<0.0001). Independent predictors of worse OS were age>60 y.o (P=0.014), synchronous metastasis (P=0.005) and WHO 2017 with significant differences between NETG1 versus NETG2 (P=0.005), NETG3 (P<0.001) and NECG3 (P<0.001). Independent predictors of worse DFS were symptomatic NET (P=0.038), pN+ status (P=0.027) and WHO 2017 with significant differences between NETG1 versus NETG3 (P=0.014) and NECG3 (P=0.009). CONCLUSION: The WHO 2017 grading system is a useful tool for patient prognosis after panNET resection and the tailoring of therapeutic strategy. Surgery could provide good results in NETG3 patients.

Level of pancreatic division and postoperative pancreatic fistula after distal pancreatectomy: A retrospective case-control study of 157 patients with non-pancreatic ductal adenocarcinoma lesions.

BACKGROUND: Several studies have suggested that the level of pancreatic division during distal pancreatectomy (DP) has an impact on postoperative pancreatic fistula (POPF) occurrence. The purpose of this study was thus to investigate the level of pancreatic division as a potential risk factor for POPF after DP for non-pancreatic ductal adenocarcinoma lesions (non-PDAC) in the era of parenchyma-sparing resection. METHODS: Data from 217 patients requiring DP were collected in a prospectively maintained database from January 1997 to December 2017 and analyzed retrospectively. Only data from patients who underwent DP using a linear stapler for non-PDAC lesions were analyzed. The outcomes of DP with body/tail division (Body-Tail group) were compared to DP with neck division (Neck group). The primary outcome was POPF according to the 2016 ISGPF. RESULTS: Data from 157 patients who underwent DP using a linear stapler for non-PDAC lesions were included for analysis. Body-Tail (n = 53) and Neck (n = 104) groups were comparable concerning demographic data, period of treatment, BMI, ASA score, comorbidities, type of lesion, median lesion size, laparoscopic or open approach and spleen preservation rate. No differences were found in POPF (5.5 and 12.5%, p = 0.388) and new-onset pancreatogenic diabetes mellitus (22.5 vs. 20%; p = 0.439) in Body-Tail and Neck groups respectively. CONCLUSION: Clinically relevant POPF and postoperative diabetes do not appear to be affected by pancreatic division level. The intention to prevent POPF or pancreatogenic diabetes should not influence the decision on level of pancreatic division during DP.