Multimodal Management of Grade 1 and 2 Pancreatic Neuroendocrine Tumors

Abstract

Pancreatic neuroendocrine tumors (p-NETs) are rare tumors with a recent growing incidence. In the 2017 WHO classification, p-NETs are classified into well-differentiated (i.e., p-NETs grade 1 to 3) and poorly differentiated neuroendocrine carcinomas (i.e., p-NECs). P-NETs G1 and G2 are often non-functioning tumors, of which the prognosis depends on the metastatic status. In the localized setting, p-NETs should be surgically managed, as no benefit for adjuvant chemotherapy has been demonstrated. Parenchymal sparing resection, including both duodenum and pancreas, are safe procedures in selected patients with reduced endocrine and exocrine long-term dysfunction. When the p-NET is benign or borderline malignant, this surgical option is associated with low rates of severe postoperative morbidity and in-hospital mortality. This narrative review offers comments, tips, and tricks from reviewing the available literature on these different options in order to clarify their indications. We also sum up the overall current data on p-NETs G1 and G2 management.

A Curious Peripancreatic Mass: A Case of an Exophytic Pancreatic Neuroendocrine Tumor

“…An exophytic or pedunculated PanNET is also an atypical finding, such as in the current case (6,7). Although the exact prevalence of the exophytic PanNET has not been reported, given that enucleation is endorsed as a surgical treatment option for exophytic PanNET, it might not be highly uncommon in clinical practice (8,9). In such cases, ambiguous tumor origin demands differential diagnoses, including peripancreatic gastrointestinal stromal tumor, peripancreatic paraganglioma, solitary fibrous tumor, and even lymph node (7).…”

Pancreatic resections or observation in management of sporadic non-functioning stage T1 neuroendocrine tumors of the pancreas (PNET) (literature review)

“…Поскольку убедительных данных об онкологических преимуществах энуклеации нет, U. Marchese и соавт. полагают, что ее не следует предлагать в качестве альтернативы радикальной резекции [39].…”

Early-onset pancreatic neuroendocrine neoplasms: A distinct disease with improved survival compared with old individuals

“…Even though there existed numerous treatment options for PanNENs, surgery remained the cornerstone of treatment, which has been proved to be with survival benefits (17)(18)(19)(20). Some studies even concluded that cancer-directed surgery can also provide improved survival outcomes in patients with distant diseases (21)(22)(23)(24)(25).…”