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Erschienen in: Die Chirurgie 8/2022

02.05.2022 | Neuroendokrine Tumoren | Leitthema

Chirurgie bei neuroendokrinen Neoplasien des Pankreas: State of the Art

verfasst von: A. Nießen, S. Schimmack, F. Billmann, T. Hackert

Erschienen in: Die Chirurgie | Ausgabe 8/2022

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Zusammenfassung

Pankreatische neuroendokrine Neoplasien (pNEN) werden mit zunehmender Inzidenz verzeichnet und vermehrt in frühen (resektablen) Stadien diagnostiziert. Aufgrund der Seltenheit dieser Neoplasien beruhen die Empfehlungen der verfügbaren Leitlinien vor allem auf retrospektiven Daten. Die onkologische und chirurgische Therapie dieser seltenen Erkrankung sollte spezialisierten Zentren vorbehalten sein. Bei resektablem Befund ohne Hinweis auf diffuse Filialisierung ist die kurativ intendierte vollständige Entfernung anzustreben. Alternativ zur chirurgischen Resektion wurde bei kleinen nichtfunktionellen Tumoren < 2 cm die Watch-and-wait-Strategie empfohlen, neuere Daten zeigen jedoch ein längeres Überleben nach Resektion von Neoplasien in der Größe zwischen 1 und 2 cm. Für benigne Insulinome und nichtfunktionelle gut differenzierte kleine pNEN stehen parenchymsparende Verfahren wie die Enukleation oder die Segmentresektion zur Verfügung. Die Frage des Einflusses von Lymphknotenmetastasen auf das langfristige tumorfreie und Gesamtüberleben und damit der Stellenwert der systematischen Lymphadenektomie ist nicht abschließend geklärt. Bei Neoplasien > 2 cm ist eine formelle Resektion mit Lymphadenektomie anzustreben. Minimal-invasive und robotisch assistierte Verfahren haben einen zunehmenden Stellenwert auch bei formellen Resektionen.
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Metadaten
Titel
Chirurgie bei neuroendokrinen Neoplasien des Pankreas: State of the Art
verfasst von
A. Nießen
S. Schimmack
F. Billmann
T. Hackert
Publikationsdatum
02.05.2022
Verlag
Springer Medizin
Erschienen in
Die Chirurgie / Ausgabe 8/2022
Print ISSN: 2731-6971
Elektronische ISSN: 2731-698X
DOI
https://doi.org/10.1007/s00104-022-01641-8