The management of pancreatic tumors varies depending on the tissue origin, as the tissue type results in numerous differences in the tumor's behavior. Pancreatic neuroendocrine tumors (pNETs) arise from pancreatic islet cells, distinguishing them from pancreatic adenocarcinomas that arise from glandular tissue. Pancreatic neuroendocrine tumors are frequently resected by pancreaticoduodenectomy. This review examines complications of pancreaticoduodenectomy in patients with pancreatic neuroendocrine tumors.

PubMed, Cochrane, Virtual Health Library, and Web of Science databases were searched for studies reporting intraoperative and postoperative complications following the resection of pNETs via pancreaticoduodenectomy. Studies that met the inclusion criteria underwent quality assessment via STROBE and CARE guidelines for observational studies and case reports, respectively.

Our search yielded 42 articles with a total relevant population of 2925. The main intraoperative complication (6.43%) was blood loss requiring blood transfusions (5.61%). Postoperative complications (55.38%) included pancreatic fistula (POPF) (21.23%), postoperative bleeding (0.31%), pancreatic hemorrhage (1.16%), delayed gastric emptying (3.90%), surgical site infection (2.02%), organ/space infection (6.36%) abdominal abscess (3.08%), bile fistula (0.72%), biliary stricture (0.068%), chyle leak (0.21), pancreatitis (0.034%) and other/unspecified complications (15%).

The postoperative complication rate for pancreaticoduodenectomy is 55.38%, with POPF being the most common. Patients with pNETs are significantly more likely to experience POPF than any other pancreatic pathology, including pancreatic adenocarcinoma. Patients with pancreatic neuroendocrine tumors are at higher risk for pancreatic fistulas due to the tumor's origin in soft pancreatic tissue and a small Wirsung duct. Pancreaticoduodenectomy is preferred for tumors larger than 2 cm or close to the duct.