Pancreatic Neuroendocrine Tumors (panNETs): Analysis of Overall Survival of Nonsurgical Management Versus Surgical Resection

Finkelstein, Paige; Sharma, R.; Picado, Omar; Gadde, Rahul; Stuart, Heather; Ripat, Caroline; Livingstone, Alan S.; Sleeman, Danny; Merchant, Nipun B.; Yakoub, Danny

doi:10.1007/s11605-017-3365-6

Cited by 73 publications

(44 citation statements)

References 50 publications

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“…Neuroendocrine neoplasms (NENs) are well known to display a wide heterogeneity as concerns histopathology, clinical presentation, treatment and prognosis. Despite their rarity, NENs have drawn a lot of attention due to the newly available therapeutic approaches, that mainly depend on tumor stage and grade (Chan et al 2017a,b, Cives & Strosberg 2017, Finkelstein et al 2017, Gallo et al 2017, Hilal 2017, Lambrescu et al 2017, Michael et al 2017, Neychev & Kebebew 2017, Rinke & Gress 2017. Since cure is difficult to achieve in most aggressive forms, therapy is mainly aimed at delaying disease progression, in order to improve prognosis.…”

Section: Introductionmentioning

confidence: 99%

Open issues on G3 neuroendocrine neoplasms: back to the future

Zatelli

Guadagno

Calzo

et al. 2018

Endocrine-Related Cancer

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The recent recognition that grade 3 (G3) neuroendocrine neoplasms (NENs) can be divided into two different categories according to the histopathological differentiation, that is G3 neuroendocrine tumors (NETs) and G3 neuroendocrine carcinomas (NECs) has generated a lot of interest concerning not only the diagnosis, but also the differential management of such new group of NENs. However, several issues need to be fully clarified in order to put G3 NETs and G3 NECs in the right place. The aim of this review is to focus on those issues that are still undetermined starting from the current knowledge, evaluating the available evidence and the possible clinical implications.

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Section: Introductionmentioning

confidence: 99%

Open issues on G3 neuroendocrine neoplasms: back to the future

Zatelli

Guadagno

Calzo

et al. 2018

Endocrine-Related Cancer

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“…Pancreatic neuroendocrine tumor (NET) is an uncommon disease comprising 1-2% of pancreatic malignancies 1) . Radical surgery for pancreatic NET offers a 5-year survival rate of 45-92% 1) , highlighting the importance of accurate diagnosis and appropriate referring of a patient for surgery.…”

Section: Introductionmentioning

confidence: 99%

“…Radical surgery for pancreatic NET offers a 5-year survival rate of 45-92% 1) , highlighting the importance of accurate diagnosis and appropriate referring of a patient for surgery. Herein, we describe a case of pancreatic NET with unusual finding on enhanced computed tomography (CT).…”

Section: Introductionmentioning

confidence: 99%

Neuroendocrine tumor within main pancreatic duct: a case report

Munekage

Maeda

Namikawa

et al. 2017

Ann. Cancer Res. Therap.

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Background: Pancreatic neuroendocrine tumor (NET) is a well-known, but uncommon disease that manifests as a heterogeneous, intense, round mass on enhanced computed tomography (CT). Herein, we report a case of pancreatic NET with unusual CT manifestation. A 66-year-old female was referred to our hospital for treatment of intermittent back pain. CT revealed a diffusely swollen pancreas from the head to tail. Imaging enhancement was weak except for a small area at the pancreatic head, and the lumen of the main pancreatic duct seemed narrowed. The entire pancreas showed accumulation of fluoro-D-glucose (FDG) on positron emission tomography (PET), suggesting autoimmune pancreatitis; however, endoscopic ultrasound-fine needle aspiration revealed atypical cells with round nuclei in a rosette formation, resulting in a diagnosis of non-functioning NET. Pathological examination revealed tumor growth within the main pancreatic duct with large areas of necrosis, and an area of viable cells at the head of the pancreas. In conclusion, CT imaging depicted an NET within the main pancreatic duct as a diffusely enlarged pancreas mimicking autoimmune pancreatitis.

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“…15 The progress in early postoperative outcomes after PD and LP has consequently led to an extension of the use for benign and premalignant neoplasms. Moreover, based on substantial data, surgical treatment is extended to small benign cystic neoplasms (< 3 cm) 16 and neuro-endocrine tumors of < 1.5-2 cm, 17 to reduce the risk of developing cancer during observational care.…”

mentioning

confidence: 99%

“…Furthermore, there is a substantial and increasing body of data that surgical management of patients with benign nf-panNETs is associated with significantly better overall survival at 1, 3, and 5 years compared to observational management, 17,39 extending the indication to surgical treatment of patients with panNETs of < 2 cm of size.…”

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confidence: 99%

Benign Tumors of the Pancreas—Radical Surgery Versus Parenchyma-Sparing Local Resection—the Challenge Facing Surgeons

Beger

2018

Journal of Gastrointestinal Surgery

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Pancreaticoduodenectomy and left-sided pancreatectomy are the surgical treatment standards for tumors of the pancreas. Surgeons, who are requested to treat patients with benign tumors, using standard oncological resections, face the challenge of sacrificing pancreatic and extra-pancreatic tissue. Tumor enucleation, pancreatic middle segment resection and local, duodenumpreserving pancreatic head resections are surgical procedures increasingly used as alternative treatment modalities compared to classical pancreatic resections. Use of local resection procedures for cystic neoplasms and neuro-endocrine tumors of the pancreas (panNETs) is associated with an improvement of procedure-related morbidity, when compared to classical Whipple OP (PD) and left-sided pancreatectomy (LP). The procedure-related advantages are a 90-day mortality below 1% and a low level of POPF B+C rates. Most importantly, the long-term benefits of the use of local surgical procedures are the preservation of the endocrine and exocrine pancreatic functions. PD performed for benign tumors on preoperative normo-glycemic patients is followed by the postoperative development of new onset of diabetes mellitus (NODM) in 4 to 24% of patients, measured by fasting blood glucose and/or oral/intravenous glucose tolerance test, according to the criteria of the international consensus guidelines. Persistence of new diabetes mellitus during the long-term follow-up after PD for benign tumors is observed in 14.5% of cases and after surgery for malignant tumors in 15.5%. Pancreatic exocrine insufficiency after PD is found in the long-term follow-up for benign tumors in 25% and for malignant tumors in 49%. Following LP, 14-31% of patients experience postoperatively NODM; many of the patients subsequently change to insulin-dependent diabetes mellitus (IDDM). The decisionmaking for cystic neoplasms and panNETs of the pancreas should be guided by the low surgical risk and the preservation of pancreatic metabolic functions when undergoing a limited, local, tissue-sparing procedure.Keywords Benign tumors of the pancreas . Parenchyma-sparing resections . Radical surgery . Local tumor extirpation . Cystic neoplasms . Neuroendocrine tumors Pancreaticoduodenectomy (PD) and left-sided pancreatectomy (LP) are highly developed surgical treatment procedures for malignant and benign pancreatic tumors.1,2 PD is the standard treatment for pancreatic head and periampullary cancers. Surgery-related postoperative complications are significantly reduced after PD following standardization of the procedure and the application of evidence-based surgical techniques.High levels of intensive care treatment and interventional management for local complications have additionally led to a considerable reduction of overall and surgery-related morbidity. The in-hospital mortality following a PD has fallen to 0-3% in specialized high-volume centers, 3-5 while large multiinstitutional reports indicate hospital mortality of 3-7%. [6][7][8][9] Following left-sided pancreatectomy-with and w...

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Pancreatic Neuroendocrine Tumors (panNETs): Analysis of Overall Survival of Nonsurgical Management Versus Surgical Resection

Abstract: Surgical resection of panNETs, including small and nonfunctioning, appears to be associated with improved OS. Enucleation is associated with shorter operative time, less blood loss, but greater incidence of POPF. Prospective, randomized clinical trials are needed to confirm these results.

Cited by 73 publications

References 50 publications

Open issues on G3 neuroendocrine neoplasms: back to the future

Open issues on G3 neuroendocrine neoplasms: back to the future

Neuroendocrine tumor within main pancreatic duct: a case report

Benign Tumors of the Pancreas—Radical Surgery Versus Parenchyma-Sparing Local Resection—the Challenge Facing Surgeons

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