Wong Kai Pun, Tsang Julian Shun, Lang Brian Hung-Hin
Division of Endocrine Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
Gland Surg. 2018 Feb;7(1):36-41. doi: 10.21037/gs.2017.12.05.
Pancreatic neuroendocrine tumours (PNETs) are rare. They are generally accepted to be slow-growing and have an indolent course. These tumours can be non-functioning or functioning, consisting of a biochemically heterogeneous group of tumours including insulinomas, gastrinomas, carcinoids and glucagonomas. Although surgery remains the mainstay of treatment, controversy still exists especially for non-functioning tumours <2 cm in size. Whether these should be resected or undergo intensive surveillance remains unclear. The surgical approach depends on local expertise. Many studies have shown comparable short-term surgical outcome with laparoscopic pancreatic resection compared to open techniques, however data on long-term oncological outcome are still lacking. On the other hand, liver metastasis occurs in as high as 80% of PNET patients. Five-year survival rate is only 30% if left untreated compared to 60-80% if complete resection is achieved. Current evidence supports liver resection with an aim for symptomatic control and to improve survival in those with respectable disease and no extra-hepatic metastasis. Palliative debunking can be considered in those with intractable symptoms. This article reviews the current evidence on pancreatic resection for PNETs, in particular the role of laparoscopic resection and the management of liver metastasis.
胰腺神经内分泌肿瘤（PNETs）较为罕见。人们普遍认为它们生长缓慢，病程进展缓慢。这些肿瘤可以是无功能性的或有功能性的，由一组生化性质各异的肿瘤组成，包括胰岛素瘤、胃泌素瘤、类癌和胰高血糖素瘤。尽管手术仍然是主要的治疗方法，但仍存在争议，尤其是对于直径小于2 cm的无功能性肿瘤。这些肿瘤是应该切除还是进行密切监测仍不明确。手术方式取决于当地的专业技术水平。许多研究表明，与开放手术相比，腹腔镜胰腺切除术的短期手术效果相当，然而长期肿瘤学结局的数据仍然缺乏。另一方面，高达80%的PNET患者会发生肝转移。如果不进行治疗，五年生存率仅为30%，而如果实现完全切除，五年生存率为60 - 80%。目前的证据支持进行肝切除，目的是控制症状，并提高那些病情可接受且无肝外转移患者的生存率。对于有难治性症状的患者，可以考虑进行姑息性减瘤手术。本文综述了目前关于PNETs胰腺切除术的证据，特别是腹腔镜切除术的作用以及肝转移的管理。
