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Pancreas| Volume 166, ISSUE 2, P164-165, August 2019

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Editorial: Small, asymptomatic, nonfunctioning pancreatic neuroendocrine tumors: Observation becoming standard of care?

      Increasing use and improved sensitivity of cross-sectional imaging has resulted in more frequent detection and diagnosis of small asymptomatic pancreatic neuroendocrine tumors (PNETs).
      • Fitzgerald T.L.
      • Hickner Z.J.
      • Schmitz M.
      • et al.
      Changing incidence of pancreatic neoplasms: a 16-year review of statewide tumor registry.
      • Kuo E.J.
      • Salem R.R.
      Population-level analysis of pancreatic neuroendocrine tumors 2 cm or less in size.
      PNETs are broadly classified as functional or nonfunctional. Functional tumors produce biologically active hormones (eg, insulin, gastrin) that cause clinical symptoms and may result in significant morbidity. For this reason, it is generally recommended that all functional tumors, regardless of size, be surgically resected when possible. However, the natural history and treatment of small (≤2 cm), sporadic, nonfunctioning (NF) PNETs, often referred to as incidentalomas, remain topics of frequent debate and continued controversy. Historically, surgeons have advocated for the routine resection of all PNETs, but recent studies have suggested that small, NF tumors exhibit a more indolent biology. Given the concern for overtreatment, which can be associated with unacceptable perioperative morbidity (without clear benefit), there seems to be growing enthusiasm for a more selective approach.
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