Surgical Management of Pancreatic Neuroendocrine Tumors

SIMPLE SUMMARY: This review, as part of a series of reviews on neuroendocrine tumors, focuses on the particular management strategies for pancreatic neuroendocrine tumors. While far less common than pancreatic ductal adenocarcinoma, neuroendocrine tumors of the pancreas are increasingly recognized in the setting of high-quality cross-sectional imaging. These tumors demonstrate a range of behavior from the nonfunctional to hormone-secreting functional tumors, and from relatively indolent neoplasms to those with more aggressive behavior. Management principles unique to these tumors are addressed, including the role of surgery for both oncologic as well as palliative goals, indications for surgery versus observation in small nonfunctional tumors, and management of metastatic disease. ABSTRACT: Pancreatic neuroendocrine tumors (PNETs) are relatively uncommon malignancies, characterized as either functional or nonfunctional secondary to their secretion of biologically active hormones. A wide range of clinical behavior can be seen, with the primary prognostic indicator being tumor grade as defined by the Ki67 proliferation index and mitotic index. Surgery is the primary treatment modality for PNETs. While functional PNETs should undergo resection for symptom control as well as potential curative intent, nonfunctional PNETs are increasingly managed nonoperatively. There is increasing data to suggest small, nonfunctional PNETs (less than 2 cm) are appropriate follow with nonoperative active surveillance. Evidence supports surgical management of metastatic disease if possible, and occasionally even surgical management of the primary tumor in the setting of widespread metastases. In this review, we highlight the evolving surgical management of local and metastatic PNETs.