Surgical Management of Pancreatic Neuroendocrine Tumors
Abstract
:Simple Summary
Abstract
1. Introduction
2. Presentation and Diagnosis of Pancreatic Neuroendocrine Tumors
3. Surgical Management of Pancreatic Neuroendocrine Tumors
3.1. Functional PNETs
3.2. Nonfunctional PNETs
3.3. Genetic Disorders
3.4. Metastatic Disease
4. New Directions in the Treatment of Pancreatic Neuroendocrine Tumors
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Well-Differentiated | |||
Ki67 Proliferation Index | Mitotic Index per High Power Field | ||
Grade 1 | <3% | <2 mitoses/2 mm2 | |
Grade 2 | 3–20% | 2–20 mitoses/2 mm2 | |
Grade 3 | >20% | >20 mitoses/2 mm2 | |
Poorly Differentiated | |||
Ki Proliferation Index | Mitotic Index per High Power Field | Cell Cytomorphology | |
Small cell | >20% | >20 mitoses/2 mm2 | Small |
Large cell | >20% | >20 mitoses/2 mm2 | Large |
Study Authors | Year | Type of Study | Number of Patients (n) | Size Cutoff | Frequency of Serial Imaging | Outcome |
---|---|---|---|---|---|---|
Lee et al. | 2012 | Retrospective cohort, single institution | 133 (56 surgery, 77 active surveillance) | <4 cm | Variable, CT or MRI | No difference in disease specific survival |
Sadot et al. | 2016 | Retrospective cohort, single institution | 181 (77 surgery, 104 active surveillance) | <3 cm | Variable | No difference in disease specific survival |
Rosenberg et al. | 2016 | Retrospective cohort, single institution | 35 (20 surgery, 15 active surveillance) | <2 cm | Every 6 months, CT or MRI | No difference in disease specific survival |
Regenet et al. | 2016 | Retrospective cohort, multi-institution | 80 (66 surgery, 14 active surveillance) | <1.7 cm | Variable | No difference in disease free survival |
Kurita et al. | 2020 | Retrospective cohort, single institution | 75 (52 surgery, 23 active surveillance) | ≤2 cm | Every 6 months, CT and EUS (for first 5 years) | No difference in overall survival |
Barenboim et al. | 2020 | Retrospective cohort, single institution | 99 (55 surgery, 44 active surveillance) | <2 cm | Every 6 months, CT; Every 12 months, Gallium [67]. DOTATOC-PET | No difference in disease specific survival |
Arra et al. | 2022 | Retrospective cohort, single institution | 64 (41 surgery, 23 active surveillance) | <2 cm | Every 6 months, CT or MRI (for first 2 years) | No difference in disease progression rate |
North American Neuroendocrine Tumor Society (NANTS) | National Comprehensive Cancer Network (NCCN) | Canadian National Expert Group | European Neuroendocrine Tumor Society (ENETS) | |
---|---|---|---|---|
Active Surveillance | Size 1 cm or less Asymptomatic | Size less than 1 cm preferred, but can selectively be observed if less than 2 cm Asymptomatic Low-grade Incidentally discovered | Size less than 2 cm Solitary lesion with no evidence of invasive disease Low Ki67 Stability on serial surveillance | Size less than or equal to 2 cm Asymptomatic Low-grade No evidence of malignant potential |
Consideration of Resection | Tumors 1–2 cm * | Invasive Node-positive tumors | Progression on surveillance | Symptomatic Higher grade (G2) Patient preference |
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Sulciner, M.L.; Clancy, T.E. Surgical Management of Pancreatic Neuroendocrine Tumors. Cancers 2023, 15, 2006. https://doi.org/10.3390/cancers15072006
Sulciner ML, Clancy TE. Surgical Management of Pancreatic Neuroendocrine Tumors. Cancers. 2023; 15(7):2006. https://doi.org/10.3390/cancers15072006
Chicago/Turabian StyleSulciner, Megan L., and Thomas E. Clancy. 2023. "Surgical Management of Pancreatic Neuroendocrine Tumors" Cancers 15, no. 7: 2006. https://doi.org/10.3390/cancers15072006