The role of minimally invasive surgery in neuroendocrine pancreatic tumors.

Minimally invasive surgery has an established role in the treatment of patients with pancreatic neuroendocrine tumors (pNETs). Enucleation is an established treatment option for insulinomas. The necessity of organ sparing surgery is well established in the case of multiple pNETs. A number of studies have demonstrated the efficacy and safety of laparoscopic surgery for the treatment of pNETs. However, pNETs are rare, and large studies focusing on pNET patients are difficult to be designed unless multicenter experience is collected. Authors investigating the role of minimally invasive pancreatic surgery should be encouraged to report separately the results that involve patients presenting with pNETs. A European registry of patients with pNETs treated with minimally invasive surgery would allow further investigation of the optimal treatment of these patients. Especially in the case of syndromic pNETs, that are rare entities, co-operation and exchange of information is needed among different centers for sharing experience and transferring knowledge. Existing data come from small cohort studies, case series and case reports. Given that, pancreatic surgery is especially demanding advanced surgery with training that is not yet standardized, further research is needed for defining its role in the treatment of pancreatic neuroendocrine tumors. Regarding the role of robot-assisted surgery in the treatment of pNETS, data are quite scarce.