Souche Regis, Hobeika Christian, Hain Elisabeth, Gaujoux Sebastien
Department of Digestive, Minimally Invasive & Oncologic Surgery, Montpellier University Hospital Centre, University of Montpellier, 641 avenue du Doyen Gaston Giraud, 34090 Montpellier, France.
Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, 47-83 Avenue de l'Hôpital, 75013 Paris, France.
J Clin Med. 2020 Sep 16;9(9):2993. doi: 10.3390/jcm9092993.
Neuroendocrine tumours of the pancreas (pNET) are rare, accounting for 1-2% of all pancreatic neoplasms. They develop from pancreatic islet cells and cover a wide range of heterogeneous neoplasms. While most pNETs are sporadic, some are associated with genetic syndromes. Furthermore, some pNETs are 'functioning' when there is clinical hypersecretion of metabolically active peptides, whereas others are 'non-functioning'. pNET can be diagnosed at a localised stage or a more advanced stage, including regional or distant metastasis (in 50% of cases) mainly located in the liver. While surgical resection is the cornerstone of the curative treatment of those patients, pNET management requires a multidisciplinary discussion between the oncologist, radiologist, pathologist, and surgeon. However, the scarcity of pNET patients constrains centralised management in high-volume centres to provide the best patient-tailored approach. Nonetheless, no treatment should be initiated without precise diagnosis and staging. In this review, the steps from the essential comprehensive preoperative evaluation of the best surgical approach (open versus laparoscopic, standard versus sparing parenchymal pancreatectomy, lymphadenectomy) according to pNET staging are analysed. Strategies to enhance the short- and long-term benefit/risk ratio in these particular patients are discussed.
胰腺神经内分泌肿瘤（pNET）较为罕见，占所有胰腺肿瘤的1%-2%。它们起源于胰岛细胞，涵盖了广泛的异质性肿瘤。虽然大多数pNET是散发性的，但有些与遗传综合征相关。此外，当存在代谢活性肽的临床分泌过多时，一些pNET是“功能性的”，而其他的则是“无功能性的”。pNET可在局部阶段或更晚期阶段被诊断出来，包括区域或远处转移（在50%的病例中），主要位于肝脏。虽然手术切除是这些患者治愈性治疗的基石，但pNET的管理需要肿瘤学家、放射科医生、病理学家和外科医生之间进行多学科讨论。然而，pNET患者数量稀少限制了在大容量中心进行集中管理，以提供最佳的个体化治疗方案。尽管如此，在没有精确诊断和分期的情况下不应开始任何治疗。在本综述中，根据pNET分期对最佳手术方法（开放手术与腹腔镜手术、标准胰腺实质切除术与保留胰腺实质的胰腺切除术、淋巴结清扫术）进行必要的全面术前评估的步骤进行了分析。讨论了提高这些特殊患者短期和长期获益/风险比的策略。
