PPS51. Resection of pancreatic neuroendocrine tumors in the setting of metastasis

Friday, March 6, 2026

3:40 PM - 4:10 PM MST

Location: HUB Poster Park - West Hall 1-3

Co-Author(s)

Daniel DePietro, MD

Assistant Professor
University of Pennsylvania
Philadelphia, Pennsylvania, United States
RR

Robert E. Roses, MD (he/him/his)

Professor of Surgery
Division of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States
Jennifer Eads, MD (she/her/hers)

Associate Professor of Clinical Medicine, Hematology/Oncology
University of Pennsylvania
Philadelphia, Pennsylvania, United States
MS

Michael C. Soulen, MD

University of Pennsylvania
Philadelphia, Pennsylvania, United States

Poster Presenter(s)

Sarah Wornow, BS

Medical Student
Perelman School of Medicine
Philadelphia, Pennsylvania, United States

Introduction: Surgical resection is recommended for small bowel neuroendocrine tumors (NETs) and is associated with improved survival, even in the presence of metastatic disease. Resection of primary pancreatic NETs (pNETs) in the metastatic setting is more controversial due to the lack of supportive evidence and the high morbidity associated with pancreatic surgery. Herein, we compared progression and overall survival of a cohort of metastatic pNET patients who underwent resection of their primary tumor to a cohort that did not undergo resection.

Methods: The healthcare systems database was searched to find primary pNET patients with metastases and at least 2 years of follow up. Patients were divided on whether they underwent primary tumor resection or not, then subdivided into those with synchronous or metachronous metastatic lesions. Unresected patients were analyzed using modified NCCN pancreatic adenocarcinoma surgical guidelines and categorized as “resectable,” (surgery possible at diagnosis) “borderline resectable,” or “locally advanced” (surgery not indicated at diagnosis). Primary outcomes included overall survival (OS) and progression-free survival (PFS), estimated by Kaplan-Meier curves. Results were compared using the log rank test. Demographics, additional treatments, tumor grade, resection type, and treatment-related adverse events were recorded.

Results: Of 284 patients with primary metastatic pNETs, 155 underwent resection and 129 did not. 31% of resected patients had an operative complication (Clavien Dindo grade 2 or greater) and 70% developed long-term morbidities (new/worsening diabetes or exocrine insufficiency). The median OS for the resected vs unresected group was 190 vs 45.6 months (HR 5.59, p< 0.0001). The median PFS of the resected vs unresected group was 38.1 vs 8.5 months (HR 2.38, p< 0.0001). Among patients with synchronous metastases, the median OS for the resected, resectable (but not resected) and locally advanced groups was 142 months (95% CI 122-162 mo), 63 months (42-84 mo) and 50 months (40-60 mo). Survival was significantly better in resected patients, HR 0.31 (95% CI 0.18-0.51), p< 0.0001, whereas potentially resectable patient who were not operated on had similar survival to the locally advanced group, HR 0.96 (0.55-1.67).

Conclusions: Resection of the primary pNET in the metastatic setting is associated with improved overall and progression free survival. A decision for pancreatectomy should anticipate frequent short and long-term morbidity.

Learning Objectives:

Participants will understand there is an association between primary pancreatic neuroendocrine tumor resection in the metastatic setting and improved survival.
Participants will understand there are short and long term morbidities associated with pancreatectomy.