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.
Pancreas. 2008; 37: 134-138
2PNETs 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.
- Kuo E.J.
- Salem R.R.
Population-level analysis of pancreatic neuroendocrine tumors 2 cm or less in size.
Ann Surg Oncol. 2013; 20: 2815-2821
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Changing incidence of pancreatic neoplasms: a 16-year review of statewide tumor registry.Pancreas. 2008; 37: 134-138
- Population-level analysis of pancreatic neuroendocrine tumors 2 cm or less in size.Ann Surg Oncol. 2013; 20: 2815-2821
- Tumor size correlates with malignancy in nonfunctioning pancreatic endocrine tumor.Surgery. 2011; 150: 75-82
- Observational study of natural history of small sporadic nonfunctioning pancreatic neuroendocrine tumors.J Clin Endocrinol Metab. 2013; 98: 4784-4789
- ENETS Consensus Guidelines for the management of patients with digestive neuroendocrine neoplasms of the digestive system: well-differentiated pancreatic non-functioning tumors.Neuroendocrinol. 2012; 95: 120-134
- Clinicopathological features of pancreatic endocrine tumors: a prospective multicenter study in Italy of 297 sporadic cases.Am J Gastroenterol. 2010; 105: 1421-1429
- Surveillance strategy for small asymptomatic non-functional pancreatic neuroendocrine tumors: a systematic review and meta-analysis.HPB (Oxford). 2017; 19: 310-320
- Prognosis of sporadic resected small (≤2 cm) nonfunctional pancreatic neuroendocrine tumors: a multi-institutional study.HPB (Oxford). 2018; 20: 251-259
- Pattern and clinical predictors of lymph node involvement in nonfunctioning pancreatic neuroendocrine tumors (NF-PanNETs).JAMA Surg. 2013; 148: 932-939
- Observation versus resection for small asymptomatic pancreatic neuroendocrine tumors: a matched case-control study.Ann Surg Oncol. 2016; 23: 1361-1370
- Management of small asymptomatic nonfunctioning pancreatic neuroendocrine tumors: limitations to apply guidelines into real life.Surgery. 2019; 166: 157-163
- Management of pancreatic endocrine tumors in multiple endocrine neoplasia type 1.World J Surg. 2006; 30: 643-653
- Multiple endocrine neoplasia type 1: clinical manifestations and management.Cancer Treat Res. 2010; 153: 287-302
- Clinical, genetic and radiographic analysis of 108 patients with von Hippel-Lindau disease (VHL) manifested by pancreatic neuroendocrine neoplasms (PNETs).Surgery. 2007; 142 (discussion 8 e1-2): 814-818
- Pancreatic neuroendocrine tumors.in: DeVita V.T. Lawrence T.S. Rosenberg S.A. Cancer Principles & Practice of Oncology. 11th ed. Wolters Kluwer, Philadelphia, PA2019: 1352-1367
- Small, nonfunctioning, asymptomatic pancreatic neuroendocrine tumors (PNETs): role for nonoperative management.Surgery. 2012; 152: 965-974
- Systematic review of active surveillance versus surgical management of asymptomatic small non-functioning pancreatic neuroendocrine neoplasms.Br J Surg. 2017; 104: 34-41
- Implications of incidentally discovered, nonfunctioning pancreatic endocrine tumors: short-term and long-term patient outcomes.Arch Surg. 2011; 146: 534-538
- Endoscopic ultrasound appearance of pancreatic serotonin-staining neuroendocrine neoplasms.Pancreatology. 2018; 18: 792-798
- Carcinoid of the pancreas: clinical characteristics and morphological features.Eur J Cancer. 1996; 32A: 1109-1116
Published online: May 13, 2019
Accepted: March 8, 2019
Conflict of interest: The authors have indicated that they have no conflict of interest regarding the content of this article.
© 2019 Elsevier Inc. All rights reserved.