Tobias Joseph, Clarke Callisia N, Gangi Alexandra, Keutgen Xavier M
Division of Surgical Oncology, Section of Endocrine Surgery, University of Chicago, Chicago, IL, USA.
Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA.
Ann Surg Oncol. 2025 May 3. doi: 10.1245/s10434-025-17390-x.
Pancreatic neuroendocrine tumors (PNETs) are comparatively rare pancreatic malignancies that exhibit diverse biologic behavior, ranging from indolent tumors to widely metastatic cancers, with up to 15 % secreting hormones that cause symptoms. As a consequence, the management of PNETs is highly individualized and can include active surveillance of small (1-2 cm) and very small (< 1 cm) nonfunctioning tumors without worrisome features, parenchymal-sparing resection of appropriately located tumors, anatomic pancreatectomy and, in select cases, debulking of metastatic disease, particularly in the liver. This review synthesizes society recommendations and contemporary evidence guiding the surgical management of PNETs. Innovations in molecular profiling and systemic therapies hold promise to refine surgical algorithms for this heterogeneous tumor.
胰腺神经内分泌肿瘤（PNETs）是相对罕见的胰腺恶性肿瘤，具有多样的生物学行为，从惰性肿瘤到广泛转移的癌症不等，高达15%的肿瘤会分泌引起症状的激素。因此，PNETs的治疗高度个体化，可包括对无不良特征的小（1-2厘米）和非常小（<1厘米）的无功能肿瘤进行主动监测，对位置合适的肿瘤进行保留实质的切除术，解剖性胰腺切除术，以及在某些情况下，对转移性疾病进行减瘤手术，尤其是在肝脏。本综述综合了社会推荐意见和当代证据，以指导PNETs的手术治疗。分子谱分析和全身治疗方面的创新有望完善针对这种异质性肿瘤的手术算法。
