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Surgical Principles in the Management of Pancreatic Neuroendocrine Neoplasms

  • Neuroendocrine Cancers (JR Strosberg, Section Editor)
  • Published:
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Opinion statement

Pancreatic neuroendocrine neoplasms (PanNENs) are increasingly recognized entities, whose incidence has dramatically grown during the last two decades. Surgery plays a pivotal role in their management as it represents the only chance of cure. Since PanNENs display a wide range of aggressiveness, their surgical management needs to be tailored on tumor’s and patient’s characteristics. Currently, there are several open questions and burning issues in the field of PanNEN, such as the management of asymptomatic nonfunctioning pancreatic neuroendocrine tumors (NF-PanNET) ≤ 2 cm. An active surveillance of these small lesions has been demonstrated to be safe although the available evidences are only based on retrospective studies. On the other hand, formal pancreatic resection associated with lymphadenectomy represents the gold standard for patients with localized NF-PanNEN > 2 cm or NF-PanNEN ≤ 2 cm in the presence of symptoms, dilation of the main pancreatic duct or suspicion of nodal metastases. Surgery plays also an important role in the setting of metastatic disease. In particular, surgery is generally recommended in the presence of low-grade, resectable, metastatic disease, but several series have reported also a survival benefit of palliative primary tumor resection in patients with unresectable liver metastases. The role of surgery in PanNEN G3 is still controversial. Indeed, surgery is associated with an improved survival in patients with well-differentiated PanNET G3, whereas there is almost no survival benefit in case of poorly differentiated lesions.

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Acknowledgments

The authors thank the ERN EURACAN initiative.

Funding

Gioja Bianca Costanza Fund supported the PhD Scholarship of Dr. Valentina Andreasi and the Research Fellowship of Dr. Francesca Muffatti.

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Authors and Affiliations

  1. Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Valentina Andreasi MD, Francesca Muffatti MD, Giovanni Guarneri MD, Massimo Falconi MD & Stefano Partelli MD, PhD

  2. Vita-Salute San Raffaele University, Milan, Italy

    Valentina Andreasi MD, Massimo Falconi MD & Stefano Partelli MD, PhD

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  1. Valentina Andreasi MD
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  2. Francesca Muffatti MD
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  3. Giovanni Guarneri MD
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  4. Massimo Falconi MD
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  5. Stefano Partelli MD, PhD
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Correspondence to Stefano Partelli MD, PhD.

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Andreasi, V., Muffatti, F., Guarneri, G. et al. Surgical Principles in the Management of Pancreatic Neuroendocrine Neoplasms. Curr. Treat. Options in Oncol. 21, 48 (2020). https://doi.org/10.1007/s11864-020-00736-w

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