Patients were operated on for a NF-pNET in case of a pNET on imaging in the absence of excessive hormone production.8 Insulinomas were diagnosed based on a 72-h fasting test. Gastrinomas were diagnosed based on hypergastrinemia and a gastrin-positive (duodenal or lymph node) neuroendocrine tumor.25 In patients with a gastrinoma and pNET on imaging, the resection was considered for a NF-pNET and gastrinoma.

Data regarding preoperative imaging were collected from conventional imaging, i.e. magnetic resonance imaging (MRI), computed tomography (CT), and endoscopic ultrasonography (EUS). From 2014 onwards, data from gallium-68-labeled imaging were obtained. Tumor size was based on conventional imaging with the shortest time before surgery.26 The number of pNETs and presence of lymph node metastases was assessed from both conventional and functional imaging.

Preoperative clinical condition was determined based on the American Society of Anesthesiology (ASA) fitness grade. The duration of surgery was calculated from skin incision until skin closure, and the length of stay (LOS) was computed from the day of surgery until the day of discharge. A readmission was defined as a hospital admission for any surgical complication after discharge. Unplanned intensive care unit (ICU) admission was documented during the initial hospital stay as well as during any readmissions. The number of days on the ICU was calculated from the day of admission until the day of discharge from the ICU. Center volume was defined as high (more than five major resections) or low volume (fewer than five major resections). Period of surgery was stratified into 2003–2010 and 2011–2017.

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