Surgical Management of Neuroendocrine Tumours of the Pancreas
Abstract
:Highlights
- Surgical management of pNETs should be planned in a multidisciplinary staff meeting.
- The initial accurate assessment is the cornerstone in pNETs management and should include accurate localisation, grading, and staging.
- Surgery should be performed for asymptomatic non-functional pNETs > 2 cm or non-functional symptomatic pNETs regardless of tumour size.
- Surgery should be performed for all functional sporadic pNETs, except those with unresectable distant metastasis.
- Parenchyma-sparing surgery is recommended for insulinoma and can be considered for non-functional pNETs < 2 cm if associated with lymph node picking.
1. Introduction
2. Preoperative Evaluation of pNET Patients
3. Indications of Surgical Resection of pNET Patients
3.1. Sporadic pNETs
3.1.1. Non-Functional pNETs
3.1.2. Insulinomas
3.1.3. Gastrinomas
3.1.4. VIPoma
3.2. pNETs Occurring in MEN1 Patients
3.2.1. MEN1 Related NF-pNETs
3.2.2. MEN1 Related Insulinoma
3.2.3. MEN1-Related Gastrinoma
3.3. G3 pNETs
3.4. Metastatic pNETs
4. Modalities of Pancreatic Resection of pNETs
4.1. Standard Surgery Versus Pancreatic Sparing Surgery
4.2. Surgical Approach: Minimally Invasive Versus Open Pancreatectomy
4.3. Short- and Long-Term Results of Pancreatic Resection in pNETs Patients
4.4. Pancreatic Resection of Functional pNETs
4.4.1. Gastrinoma
4.4.2. Insulinoma
4.5. The Value of Lymphadenectomy in pNETs Surgery
5. Recurrence Rate and Follow-Up after Resection
6. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Name | Symptoms | Secretion | Incidence New Case//Million/yr. | Location | Malignant | MEN-1 Context | Surgery | Procedure |
---|---|---|---|---|---|---|---|---|
Insulinoma | Whipple’s triad: Low blood sugar, presence of symptoms, and reversal of these symptoms when the glucose serum level is restored to normal Many other, like confusion, behavioral changes, visual troubles | insulin | 1–32 | Variable | <10% | 4–5% | Always | Sparing parenchymal pancreatectomy |
Gastrinoma | Zollinger-Ellison syndrome: Gastric acid hypersecretion, severe peptic ulceration, profuse diarrhea | gastrin | 0.5–21.5 | Stabile & Passaro triangle | 60% | 20–25% | yes (unless MEN-1 gastrinoma < 2 cm) | Sparing parenchymal or standard pancreatectomy |
Glucagonoma | Hyperglycemia, necrotic migratory erythema | glucagon | 0.01–0.1 | Variable | 50–80% | 1–20% | yes | Sparing parenchymal or standard pancreatectomy |
Vipoma | WDHA syndrome Watery diarrhea, hypokalemia, acidosis | VIP | 0.05–0.2 | Variable | 60–80% | 6% | yes | Standard pancreatectomy |
Somatostinoma | Pain, diabetes, diarrhea, gallstones | somatostatin | <0.02 | Variable | 70–92% | 45% | yes | Standard pancreatectomy |
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Souche, R.; Hobeika, C.; Hain, E.; Gaujoux, S. Surgical Management of Neuroendocrine Tumours of the Pancreas. J. Clin. Med. 2020, 9, 2993. https://doi.org/10.3390/jcm9092993
Souche R, Hobeika C, Hain E, Gaujoux S. Surgical Management of Neuroendocrine Tumours of the Pancreas. Journal of Clinical Medicine. 2020; 9(9):2993. https://doi.org/10.3390/jcm9092993
Chicago/Turabian StyleSouche, Regis, Christian Hobeika, Elisabeth Hain, and Sebastien Gaujoux. 2020. "Surgical Management of Neuroendocrine Tumours of the Pancreas" Journal of Clinical Medicine 9, no. 9: 2993. https://doi.org/10.3390/jcm9092993