Functional Status and Postoperative Outcomes After Left Pancreatectomy for Pancreatic Neuroendocrine Tumors: An Exploratory Analysis from the Prospective SPANDISPAN Study

Background: Whether tumor functional status influences postoperative outcomes after left pancreatectomy (LP) for pancreatic neuroendocrine tumors (pNETs) remains unknown. We evaluated the association between functional status, perioperative management, and postoperative outcomes in a prospective nationwide cohort of patients undergoing LP for pNET. Methods: This prespecified analysis of the prospective multicenter SPANDISPAN study included consecutive patients undergoing elective LP at 41 Spanish hospitals between February 2022 and January 2023. Of 98 patients with pNET, functional status was available in 88 (14 functioning and 74 non-functioning tumors). Perioperative characteristics, spleen preservation, and postoperative outcomes were compared according to tumor functional status. Results: Spleen preservation was performed in 28.6% of functioning and 18.9% of non-functioning tumors (p = 0.472; risk difference 9.7 percentage points, 95% CI [confidence interval] −15.6 to 34.9). Patients with functioning tumors had lower rates of clinically relevant postoperative pancreatic fistula (7.1% vs. 36.5%; p = 0.032; risk difference −29.3 percentage points, 95% CI −46.7 to −12.0), shorter length of hospital stay (median 4 vs. 7 days; p = 0.036), and no 90-day readmissions (0% vs. 31.1%; p = 0.017; risk difference −31.1 percentage points, 95% CI −41.6 to −20.5). Tumor functional status was not significantly associated with the use of spleen-preserving resection. Conclusions: Functional status is associated with clinically relevant differences in postoperative outcomes after LP for pNET. Patients with functioning tumors experienced lower postoperative morbidity than those with non-functioning tumors, whereas no statistically significant association was detected between tumor functional status and spleen preservation. These exploratory findings suggest that tumor functional status may warrant consideration as an additional factor in perioperative risk stratification and patient counseling, pending confirmation in larger, adequately powered studies; spleen preservation should continue to be guided by established oncological criteria.

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Journal
Journal of Clinical Medicine
Published
2026-09-11
DOI
https://doi.org/10.3390/jcm15187035
Primary Topic
Pancreatic and Hepatic Oncology Research
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article
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article

Functional Status and Postoperative Outcomes After Left Pancreatectomy for Pancreatic Neuroendocrine Tumors: An Exploratory Analysis from the Prospective SPANDISPAN Study

Francisco J. Alcalá, Javier Mínguez, Manuel González, Enrique Asensio et al.
Journal of Clinical Medicine
Pancreatic and Hepatic Oncology Research
article

Functional Status and Postoperative Outcomes After Left Pancreatectomy for Pancreatic Neuroendocrine Tumors: An Exploratory Analysis from the Prospective SPANDISPAN Study

Francisco J. Alcalá, Javier Mínguez, Manuel González, Enrique Asensio, Marina Garcés‐Albir, Alberto Miyar, Isabel Jaén-Torrejimeno, Manuel Nogueira Sixto, Natalia Zambudio, Miguel Ángel Gómez‐Bravo, Jose E. Quinones, Luis Secanella, Enrique Artigues, Nuria Fuentes‐Peláez, Juan Luís Blas, Carmelo Loinaz, Pablo Martí‐Cruchaga, Elia Marques, Carmen Payá, Belinda Sanchez, Ana Belén Vico, Betsabé Reyes, Belén Hernández, Santiago López‐Ben, Carmen González-Serrano, Pilar Elena González, Santiago Sánchez-Cabús, C. Alcázar, Daniel Aparicio-López, Fernando Burdı́o, Alicia Calero, Cristina Ballester Ibáñez, C. Villodre, Antonio Calvo, María del Carmen Manzanares, Juan Jesús Rubio-García, D. Pacheco, M I García-Domingo, Miguel Ángel Suárez Muñóz, Juli Busquets, Gerardo Blanco‐Fernández, José Manuel Ramia, Fulthon Vela, Francisco Espín Álvarez, Gloria Palomares, Itziar de-Ariño-Hervás, José I. Miota-de-Llamas, Benedetto Ielpo, Míriam Alkorta, Berta Tió, Esteban Cugat, J. García i Castell, María J. de Castro, Benito González Conde, Alberto Carabias, Adelino Patricio Pérez-Morera, Lorena Solar, María Paloma Sanz-Muñóz, Belen Martın, Alfredo Escartín, Jorge Calvo, Fernando Rotellar, Enrique Toledo, Jorge Roldán de la Rúa, Mario Rodríguez, María Galófre, Sandra Ruiz, Inmaculada Lasa, Luis Díez, Gabriel García, Carlos Domingo, Luis Sabater, Gonzalo Suárez, Angélica Blanco, Mario Serradilla-Martín, Sergio Estévez, María del Mar Achalandabaso, Rafael López-Andújar, Julio Santoyo
article en

Abstract

Background: Whether tumor functional status influences postoperative outcomes after left pancreatectomy (LP) for pancreatic neuroendocrine tumors (pNETs) remains unknown. We evaluated the association between functional status, perioperative management, and postoperative outcomes in a prospective nationwide cohort of patients undergoing LP for pNET. Methods: This prespecified analysis of the prospective multicenter SPANDISPAN study included consecutive patients undergoing elective LP at 41 Spanish hospitals between February 2022 and January 2023. Of 98 patients with pNET, functional status was available in 88 (14 functioning and 74 non-functioning tumors). Perioperative characteristics, spleen preservation, and postoperative outcomes were compared according to tumor functional status. Results: Spleen preservation was performed in 28.6% of functioning and 18.9% of non-functioning tumors (p = 0.472; risk difference 9.7 percentage points, 95% CI [confidence interval] −15.6 to 34.9). Patients with functioning tumors had lower rates of clinically relevant postoperative pancreatic fistula (7.1% vs. 36.5%; p = 0.032; risk difference −29.3 percentage points, 95% CI −46.7 to −12.0), shorter length of hospital stay (median 4 vs. 7 days; p = 0.036), and no 90-day readmissions (0% vs. 31.1%; p = 0.017; risk difference −31.1 percentage points, 95% CI −41.6 to −20.5). Tumor functional status was not significantly associated with the use of spleen-preserving resection. Conclusions: Functional status is associated with clinically relevant differences in postoperative outcomes after LP for pNET. Patients with functioning tumors experienced lower postoperative morbidity than those with non-functioning tumors, whereas no statistically significant association was detected between tumor functional status and spleen preservation. These exploratory findings suggest that tumor functional status may warrant consideration as an additional factor in perioperative risk stratification and patient counseling, pending confirmation in larger, adequately powered studies; spleen preservation should continue to be guided by established oncological criteria.

Journal of Clinical MedicineVol. 15(18)
Universitat de Miguel Hernández d'Elx (ES), University of Alicante (ES), Hospital Universitario Insular de Gran Canaria (ES), Hospital de Sant Pau (ES), Bellvitge University Hospital (ES), Hospital Universitari Arnau de Vilanova (ES), University Hospital Complex Of Vigo (ES), Hospital Clínico San Carlos (ES), Hospital Universitario Nuestra Señora de Candelaria (ES), Hospital General Universitario Morales Meseguer (ES), Hospital de Basurto (ES), Hospital La Luz (ES), University Hospital Mútua de Terrassa (ES), Complejo Hospitalario de Salamanca (ES), Marqués de Valdecilla University Hospital (ES), Biogipuzkoa Health Research Institute (ES), Hospital Universitario 12 De Octubre (ES), Hospital Royo Villanova (ES), Hospital Universitario de Getafe (ES), Hospital Universitario Príncipe de Asturias (ES), Hospital Regional Universitario de Málaga (ES), Instituto de Investigación Biosanitaria de Granada (ES), Hospital General Universitario de Elche (ES), Hospital Universitario Virgen de las Nieves (ES), Hospital General Universitario de Ciudad Real (ES), Hospital Universitario Doctor Peset (ES), Hospital General Universitario De Valencia (ES), Hospital Mare de Déu de la Mercè (ES), Mútua Terrassa (ES), Hospital Del Mar (ES), Hospital Universitario Central de Asturias (ES), Clinica Universidad de Navarra (ES), Hospital General Universitario de Alicante Doctor Balmis (ES), Centro de Implantología Cirugía Oral y Maxilofacial (ES), Donostiako Unibertsitate Ospitalea (ES), Complexo Hospitalario Universitario A Coruña (ES), Hospital Universitario Puerta del Mar (ES), Hospital General Universitario de Albacete (ES), Hospital General de Elda (ES), Hospital Universitario Virgen del Rocío (ES), Hospital Universitari Germans Trias i Pujol (ES), Hospital Universitari de Girona Doctor Josep Trueta (ES), Hospital Clínico Universitario Virgen de la Victoria (ES), Hospital Clínico Universitario de Valladolid (ES), Hospital Universitario Río Hortega (ES), INCLIVA Health Research Institute (ES), Hospital Universitario Infanta Leonor (ES), Instituto de Investigación Sanitaria La Fe (ES)
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