Division of Surgical Oncology, Eastern Virginia Medical School, Norfolk, Virginia.
Division of Surgical Oncology, Eastern Virginia Medical School, Norfolk, Virginia.
Endocr Pract. 2024 Oct;30(10):908-916. doi: 10.1016/j.eprac.2024.07.010. Epub 2024 Jul 18.
Pancreatic neuroendocrine tumors (PNETs) are uncommon tumors which are increasing in incidence. The management of these tumors continues to evolve. This review examines the current role of surgery in the treatment of these tumors.
Studies published over the past 10 years were identified using several databases including PubMed, MEDLINE, and Science Direct. Search terms included PNETs, treatment, and surgery. Clinical practice guidelines and updates from several major groups were reviewed.
Surgery continues to have a major role in the treatment of sporadic functional and nonfunctional PNETs. Pancreas-sparing approaches are increasingly accepted as alternatives to formal pancreatic resection in selected patients. Options such as watch and wait or endoscopic ablation may be reasonable alternatives to surgery for non-functional PNETs < 2 cm in size. Surgical decision-making in multiple endocrine neoplasia type 1 patients remains complex and in some situations such as gastrinoma quite controversial. The role of surgery has significantly diminished in patients with advanced disease due to the advent of more effective systemic and liver-directed therapies. However, the optimal treatments and sequencing in advanced disease remain poorly defined, and it has been suggested that surgery is underutilized in these patients.
Surgery remains a major treatment modality for PNETs. Given the plethora of available treatments, ongoing controversies and the changing landscape, management has become increasingly complex. An experienced multidisciplinary team which includes surgery is essential to manage these patients.
胰腺神经内分泌肿瘤（PNETs）是一种发病率不断增加的罕见肿瘤。这些肿瘤的治疗方法仍在不断发展。本综述检查了手术在这些肿瘤治疗中的当前作用。
使用包括 PubMed、MEDLINE 和 Science Direct 在内的多个数据库，确定了过去 10 年发表的研究。搜索词包括 PNETs、治疗和手术。审查了来自多个主要团体的临床实践指南和更新。
手术在治疗散发性功能性和非功能性 PNETs 中仍然具有重要作用。在选定的患者中，胰腺保留方法越来越被视为正式胰腺切除术的替代方法。对于大小<2cm 的非功能性 PNETs，观察和等待或内镜消融等选择可能是手术的合理替代方案。对于多发性内分泌肿瘤 1 型患者，手术决策仍然很复杂，在某些情况下，如胃泌素瘤，争议很大。由于更有效的全身和肝靶向治疗的出现，手术在晚期疾病患者中的作用显著降低。然而，晚期疾病的最佳治疗方法和治疗顺序仍未明确定义，并且有人认为这些患者的手术使用率较低。
手术仍然是 PNETs 的主要治疗方式。鉴于有大量的治疗方法，持续存在的争议和不断变化的局面，管理变得越来越复杂。一个包括手术在内的经验丰富的多学科团队对于管理这些患者至关重要。
