Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
Vita-Salute San Raffaele University, Milan, Italy.
Curr Treat Options Oncol. 2020 Apr 30;21(6):48. doi: 10.1007/s11864-020-00736-w.
Pancreatic neuroendocrine neoplasms (PanNENs) are increasingly recognized entities, whose incidence has dramatically grown during the last two decades. Surgery plays a pivotal role in their management as it represents the only chance of cure. Since PanNENs display a wide range of aggressiveness, their surgical management needs to be tailored on tumor's and patient's characteristics. Currently, there are several open questions and burning issues in the field of PanNEN, such as the management of asymptomatic nonfunctioning pancreatic neuroendocrine tumors (NF-PanNET) ≤ 2 cm. An active surveillance of these small lesions has been demonstrated to be safe although the available evidences are only based on retrospective studies. On the other hand, formal pancreatic resection associated with lymphadenectomy represents the gold standard for patients with localized NF-PanNEN > 2 cm or NF-PanNEN ≤ 2 cm in the presence of symptoms, dilation of the main pancreatic duct or suspicion of nodal metastases. Surgery plays also an important role in the setting of metastatic disease. In particular, surgery is generally recommended in the presence of low-grade, resectable, metastatic disease, but several series have reported also a survival benefit of palliative primary tumor resection in patients with unresectable liver metastases. The role of surgery in PanNEN G3 is still controversial. Indeed, surgery is associated with an improved survival in patients with well-differentiated PanNET G3, whereas there is almost no survival benefit in case of poorly differentiated lesions.
胰腺神经内分泌肿瘤（PanNENs）是越来越受到认可的实体瘤，其发病率在过去二十年中急剧增加。手术在其治疗中起着关键作用，因为它是唯一治愈的机会。由于 PanNENs 表现出广泛的侵袭性，其手术管理需要根据肿瘤和患者的特征进行定制。目前，在 PanNEN 领域存在几个悬而未决的问题和热点问题，例如无症状非功能性胰腺神经内分泌肿瘤（NF-PanNET）≤2cm 的处理。尽管现有证据仅基于回顾性研究，但已经证明对这些小病变进行积极监测是安全的。另一方面，对于局部 NF-PanNEN > 2cm 或 NF-PanNEN≤2cm 伴有症状、主胰管扩张或怀疑淋巴结转移的患者，进行规范化的胰腺切除术联合淋巴结清扫术是金标准。手术在转移性疾病的治疗中也起着重要作用。特别是，在存在低度、可切除、转移性疾病的情况下，通常推荐手术，但有几个系列报告称，对于无法切除肝转移的患者，姑息性原发肿瘤切除术也有生存获益。手术在 PanNEN G3 中的作用仍存在争议。实际上，手术与分化良好的 PanNET G3 患者的生存改善相关，而在分化差的病变中几乎没有生存获益。
