AI Article Synopsis
- Pancreatic neuroendocrine tumors (PNETs) are rare but increasingly common, and their surgical management is evolving.
- Recent studies highlight that surgery is crucial for treating both functional and nonfunctional PNETs, with a shift toward less invasive techniques for selected cases.
- Advanced disease has complicated surgical options, as new therapies are emerging, but optimal treatment plans, including the role of surgery, are still unclear and require a skilled multidisciplinary approach.
Article Abstract
Objective: Pancreatic neuroendocrine tumors (PNETs) are uncommon tumors which are increasing in incidence. The management of these tumors continues to evolve. This review examines the current role of surgery in the treatment of these tumors.
Methods: Studies published over the past 10 years were identified using several databases including PubMed, MEDLINE, and Science Direct. Search terms included PNETs, treatment, and surgery. Clinical practice guidelines and updates from several major groups were reviewed.
Results: Surgery continues to have a major role in the treatment of sporadic functional and nonfunctional PNETs. Pancreas-sparing approaches are increasingly accepted as alternatives to formal pancreatic resection in selected patients. Options such as watch and wait or endoscopic ablation may be reasonable alternatives to surgery for non-functional PNETs < 2 cm in size. Surgical decision-making in multiple endocrine neoplasia type 1 patients remains complex and in some situations such as gastrinoma quite controversial. The role of surgery has significantly diminished in patients with advanced disease due to the advent of more effective systemic and liver-directed therapies. However, the optimal treatments and sequencing in advanced disease remain poorly defined, and it has been suggested that surgery is underutilized in these patients.
Conclusions: Surgery remains a major treatment modality for PNETs. Given the plethora of available treatments, ongoing controversies and the changing landscape, management has become increasingly complex. An experienced multidisciplinary team which includes surgery is essential to manage these patients.
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| http://dx.doi.org/10.1016/j.eprac.2024.07.010 | DOI Listing |
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