Erschienen in:
24.09.2020 | ASO Author Reflections
ASO Author Reflections: Refining the Surgical Management of Pancreatic Neuroendocrine Tumors
verfasst von:
Jordan M. Cloyd, MD, George A. Poultsides, MD, MS
Erschienen in:
Annals of Surgical Oncology
|
Ausgabe 2/2021
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Excerpt
Well-differentiated pancreatic neuroendocrine tumors (PNETs) are a heterogeneous neoplasm whose clinical presentation can range from small incidental tumors to advanced metastatic disease. PNETs also vary depending on their biological aggressiveness, typically measured by the Ki67 proliferative index, and whether they produce symptoms characteristic of classic clinical syndromes. Due to more widespread use of cross-sectional imaging and advanced endoscopic procedures, the incidence of PNETs, particularly early-stage disease, is increasing. Traditionally, formal pancreatectomy and regional lymphadenectomy has been the standard approach for patients with localized disease; however, increasing evidence suggests that active surveillance is a safe strategy for small asymptomatic tumors and that pancreas/spleen-preserving approaches are reasonable for those at low-risk for lymph node metastases. On the other hand, recent developments in systemic therapies have enabled the selection of patients for whom aggressive surgical approaches may benefit. In the accompanying Landmark Series review, we highlight the critical studies that define the contemporary surgical management of PNETs.
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