Update on the Surgical Treatment of Pancreatic Neuroendocrine Tumors

Background and Aims: Pancreatic neuroendocrine tumors (PNET) arise from uncontrolled proliferation of neuroendocrine cell and further genetic alterations that may induce hormone secretion such as glucagon/insulin/gastrin/VIP. Their incidence is rapidelly growing, especially because of the frequent incidental diagnosis of small asymptomatic non-functionnal neuroendocrine tumors with the widespread use of cross-sectional imaging. The vast majority of pancreatic neuroendocrine tumors are sporadic but up to 5%–10% of them arise from genetic syndromes, the main one being Multiple Endocrine Neopalsm type 1 (MEN1). Appropriate management of patients with PNET is a complex challenge for surgeons, and require extensive medical collaboration. This review aims to summarize major and recent updates regarding the medico-surgical management of PNETs. Material and Methods: Review of pertinent English language literature. Results: This article provides a concise summary of the clinical presentation, diagnosis, surgical management, alternative treatments and follow up of PNETs. Conclusion: PNET are a rare, heterogeneous group of neoplasms with a generally favorable prognosis at least compared to pancreatic adenocarcinoma. Surgical resection is the cornerstone of their management, particularly for localized disease, and should always be discussed in multidisciplinary tumor board.

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Updated Surgical Management of Pancreatic Neuroendocrine Tumors

Journal of Surgical Case Reports and Images ◽

10.31579/2690-1897/026 ◽

2020 ◽

Vol 3 (3) ◽

pp. 01-05

Author(s):

Abdelkader Boukerrouche

Keyword(s):

Neuroendocrine Tumors ◽

Hormone Secretion ◽

Radical Resection ◽

Genetic Alterations ◽

Therapeutic Strategies ◽

Pancreatic Neuroendocrine Tumors ◽

Genetic Syndromes ◽

Parenchyma Sparing ◽

Very High

The incidence of pancreatic neuroendocrine tumors (PNETs) is growing, related in part to increased incidental diagnosis of small asymptomatic non-functionnal tumors. Arised from uncontrolled proliferation of neuroendocrine cell with genetic alterations inducing hormone secretion, the PNETs are majorly sporadic, non-functional, and associated with genetic syndromes, mainly Multiple Endocrines Neoplasm type 1 (MEN1) in up to 5%–10% of cases. Because of the very high heterogeneity, optimizing management and standardizing therapeutic strategies for PNETs remains a challenge for surgeons, requiring a multidisciplinary collaboration. Surgery for PNETs has evolved varying from radical resection to parenchyma sparing surgery and even now a selective conservative management. This review work aims to provide an update regarding the surgical treatment for PNETs, in the light of recent published reports.

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Surgical management of pancreatic neuroendocrine tumors

Gastroenterology ◽

10.1016/s0016-5085(00)81920-4 ◽

2000 ◽

Vol 118 (4) ◽

pp. A1504-A1505

Author(s):

Mark F. Berry ◽

Noel N. Williams ◽

Jason H. Lee ◽

Richard Whittington ◽

Robert J. Canter ◽

...

Keyword(s):

Surgical Management ◽

Neuroendocrine Tumors ◽

Pancreatic Neuroendocrine Tumors

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Pancreatic Neuroendocrine tumors (NET). Surgical Management and Outcome.

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2007.07.059 ◽

2007 ◽

Vol 33 (9) ◽

pp. 1111-1111

Author(s):

E AHMED ◽

H KHALIFA ◽

H KHALIL ◽

M ELSHERBINY ◽

H ABOULKASSEM

Keyword(s):

Surgical Management ◽

Neuroendocrine Tumors ◽

Pancreatic Neuroendocrine Tumors

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Treatment Options for Pancreatic Neuroendocrine Tumors

Cancers ◽

10.3390/cancers11060828 ◽

2019 ◽

Vol 11 (6) ◽

pp. 828 ◽

Cited By ~ 9

Author(s):

Amit Akirov ◽

Vincent Larouche ◽

Sameerah Alshehri ◽

Sylvia L. Asa ◽

Shereen Ezzat

Keyword(s):

Neuroendocrine Tumors ◽

Treatment Options ◽

Distant Metastases ◽

Mass Effect ◽

Tumor Burden ◽

Management Approach ◽

Pancreatic Neuroendocrine Tumors ◽

Genetic Syndromes ◽

Stratification System ◽

Specific Symptoms

The management of pancreatic neuroendocrine tumors (PanNETs) involves classification into non-functional or functional PanNET, and as localized or metastatic PanNET. In addition, while most PanNETs are sporadic, these endocrine neoplasms can also be manifestations of genetic syndromes. All these factors may assist in forming a risk stratification system permitting a tailored management approach. Most PanNETs are classified as non-functional because they are not associated with clinical sequelae of hormone excess. They are characterized by non-specific symptoms, such as abdominal pain or weight loss, resulting from mass effect related to the pancreatic tumor or secondary to distant metastases. Accurate staging of the disease is essential for determining the appropriate approach to therapy. As cure is only potentially possible with surgical resection of the tumor, it is recommended to remove all localized and limited metastatic disease. However, many patients present with metastatic and/or advanced local disease. In such instances, the goal of therapy is to control tumor growth and/or decrease tumor burden, lengthen survival, and palliate local symptoms and those of hormone excess. This typically requires a multimodal approach, including surgery, liver-directed treatment, and systemic medical therapy.

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