Updated Surgical Management of Pancreatic Neuroendocrine Tumors

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.

scholarly journals Update on the Surgical Treatment of Pancreatic Neuroendocrine Tumors

2020 ◽  
Vol 109 (1) ◽  
pp. 42-52 ◽  
Author(s):  
F. Jeune ◽  
A. Taibi ◽  
S. Gaujoux
Keyword(s):  
Surgical Management ◽  
Neuroendocrine Tumors ◽  
English Language ◽  
Hormone Secretion ◽  
Genetic Alterations ◽  
Tumor Board ◽  
Pancreatic Neuroendocrine Tumors ◽  
Genetic Syndromes ◽  
Cross Sectional ◽  
Management Alternative

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.

scholarly journals Treatment Options for Pancreatic Neuroendocrine Tumors

Cancers ◽  
2019 ◽  
Vol 11 (6) ◽  
pp. 828 ◽  
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.

Parenchyma-sparing pancreatectomies for pancreatic neuroendocrine tumors

2015 ◽  
Vol 2 (3) ◽  
pp. 217-227
Author(s):  
Rim Cherif ◽  
Sébastien Gaujoux ◽  
Jérome Cros ◽  
Philippe Ruszniewski ◽  
Alain Sauvanet
Keyword(s):  
Neuroendocrine Tumors ◽  
Pancreatic Neuroendocrine Tumors ◽  
Parenchyma Sparing

scholarly journals Plasma chromogranin A in patients with sporadic gastro-entero-pancreatic neuroendocrine tumors or multiple endocrine neoplasia type 1

2003 ◽  
pp. 39-43 ◽  
Author(s):  
M Peracchi ◽  
D Conte ◽  
C Gebbia ◽  
C Penati ◽  
S Pizzinelli ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Primary Hyperparathyroidism ◽  
Neuroendocrine Tumors ◽  
Chromogranin A ◽  
Multiple Endocrine Neoplasia ◽  
Multiple Endocrine Neoplasia Type ◽  
Pancreatic Neuroendocrine Tumors ◽  
Men 1 ◽  
Endocrine Neoplasia

OBJECTIVE: As circulating chromogranin A (CgA) has been claimed to be the best general neuroendocrine marker so far available, we evaluated the usefulness of CgA determination in the clinical assessment of patients with sporadic gastro-entero-pancreatic neuroendocrine tumors (GEP NETs) or multiple endocrine neoplasia type 1 (MEN 1). DESIGN AND METHODS: Plasma CgA levels were measured using a commercial enzyme-linked immunosorbent assay in 61 patients with sporadic GEP NET and in 25 with MEN 1 including 16 with GEP NET. Controls were 50 healthy volunteers, 46 patients with pituitary adenoma and 35 patients with primary hyperparathyroidism. RESULTS: The cutoff value for CgA established in our healthy subjects (as mean+2 s.d.) was 20 U/l. CgA levels were above the normal range in 71/77 patients with sporadic or MEN 1-related GEP NETs (92%), in four out of nine MEN 1 patients without GEP NETs (44%), and only in 22/81 control patients with pituitary or parathyroid disease (27%). Furthermore, CgA levels of over 100 U/l occurred in 36/77 patients with GEP NETs (47%) and only in one patient with a non-functioning pituitary adenoma. In the patients with GEP NETs, both tumor burden and secretory activity affected CgA levels, and successful surgical resection was associated with markedly decreased CgA values. CONCLUSIONS: Plasma CgA was confirmed to be a reliable marker for GEP NETs. Moreover, in MEN 1 patients the finding of very high CgA levels strongly suggests the presence of a GEP NET, as both primary hyperparathyroidism and pituitary adenomas rarely cause marked CgA increases.

scholarly journals Conservative management and parenchyma-sparing resections of pancreatic neuroendocrine tumors: Literature review

2015 ◽  
Vol 21 ◽  
pp. S10-S14 ◽  
Author(s):  
Claudio Mauriello ◽  
Salvatore Napolitano ◽  
Claudio Gambardella ◽  
Giancarlo Candela ◽  
Ferdinando De Vita ◽  
...  
Keyword(s):  
Literature Review ◽  
Neuroendocrine Tumors ◽  
Conservative Management ◽  
Pancreatic Neuroendocrine Tumors ◽  
Parenchyma Sparing
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