Surgical Versus Nonsurgical Management of Pancreatic Neuroendocrine Tumors: A Systematic Review and Meta-Analysis

Abstract

Background: Pancreatic neuroendocrine tumors (PNETs) are a rare type of pancreatic cancer. Surgical resection is the primary curative treatment option, but whether this is the optimal treatment remains debatable. To address this question, we compared surgical versus nonsurgical management of PNETs. Patients and Methods: We searched the Medline (via PubMed), Scopus, Web of Science, and Embase databases through the end of 2023. Studies that compared surgical and nonsurgical interventions for PNETs across all grades, stages, and sizes and that reported survival outcomes were included. The primary endpoint was overall survival. The meta-analysis was performed using STATA software. Results: Seventy-seven articles (including 62 654 patients) were included in the final analysis. The pooled hazard ratio (HR) for mortality of surgical versus nonsurgical management was 0.30 (95% confidence interval [CI], 0.26–0.34; P < 0.001). Compared with nonsurgical management, surgical management was associated with better 1-year (94% vs. 78%), 3-year (85% vs. 57%), 5-year (77% vs. 46%), and 10–year (64% vs. 34%) survival. Pooled HRs for the mortality of patients who underwent surgery versus nonsurgical management for functional, nonfunctional, low grade (G1/G2), small (< 2 cm), and metastatic/locally advanced PNETs were 0.30, 0.30, 0.31, 0.26, and 0.33 respectively (P < 0.001). Surgical management of small PNETs (< 1 cm) showed comparable survival rates between surgical and nonsurgical approaches. Conclusions: Surgical PNET management had better outcomes than nonsurgical PNET management and should be considered the primary treatment option for resectable PNETs, However, nonsurgical management may be a reasonable option for select patients with small (<1 cm), asymptomatic PNETs.