Abstract

Pancreatic neuroendocrine tumors (PNETs) are rare neoplasms that are frequently diagnosed at a late stage, particularly the non-functional subtypes that lack hormone-related symptoms. Reported risk factors include diabetes mellitus and a family history of malignancy. Minimally invasive surgery (MIS) has gained acceptance as an alternative to open pancreatectomy, with evidence suggesting comparable perioperative and oncologic outcomes, especially for distal pancreatic tumors; however, data remain limited regarding right-sided tumors and long-term outcomes, warranting further investigation. This systematic review and meta-analysis were conducted according to PRISMA guidelines. A comprehensive literature search identified comparative studies evaluating minimally invasive versus open pancreatectomy for PNETs. Study selection, data extraction, and quality assessment were performed independently. A random-effects meta-analysis was conducted using R software to calculate pooled risk ratios (RRs), mean differences (MDs), and measures of heterogeneity. Eight cohort studies published between 2017 and 2022 were included, comprising 2,210 patients (934 MIS and 1,253 open). Meta-analysis demonstrated no significant differences between MIS and open surgery in post operative pancreatic fistula (RR = 1.07), hemorrhage (RR = 0.86), overall morbidity (RR = 0.87), or R0 resection rate (RR = 1.04). MIS was associated with significantly lower recurrence (RR = 0.28, P = 0.005), shorter length of hospital stay (MD = –2.97 days, p < 0.0001), and reduced intraoperative blood loss (MD = –199.4 mL, p = 0.018). All included studies were rated as “good” quality using NIH assessment criteria. In conclusion, minimally invasive distal pancreatectomy is a safe and effective approach for selected patients with PNETs, offering outcomes comparable to open surgery while providing advantages in recurrence, blood loss, and hospitalization.

Key words: Pancreatic neuroendocrine tumors, open, Minimally