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Current Management of Pancreatic Neuroendocrine Tumors: From Demolitive Surgery to Observation

Incidental diagnosis of pancreatic neuroendocrine tumors (PanNETs) greatly increased in the last years. In particular, more frequent diagnosis of small PanNETs leads to many challenging clinical decisions. These tumors are mostly indolent, although a percentage (up to 39%) may reveal an aggressive b...

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Autores principales: Bartolini, Ilenia, Bencini, Lapo, Risaliti, Matteo, Ringressi, Maria Novella, Moraldi, Luca, Taddei, Antonio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6081603/
https://www.ncbi.nlm.nih.gov/pubmed/30140282
http://dx.doi.org/10.1155/2018/9647247
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author Bartolini, Ilenia
Bencini, Lapo
Risaliti, Matteo
Ringressi, Maria Novella
Moraldi, Luca
Taddei, Antonio
author_facet Bartolini, Ilenia
Bencini, Lapo
Risaliti, Matteo
Ringressi, Maria Novella
Moraldi, Luca
Taddei, Antonio
author_sort Bartolini, Ilenia
collection PubMed
description Incidental diagnosis of pancreatic neuroendocrine tumors (PanNETs) greatly increased in the last years. In particular, more frequent diagnosis of small PanNETs leads to many challenging clinical decisions. These tumors are mostly indolent, although a percentage (up to 39%) may reveal an aggressive behaviour despite the small size. Therefore, there is still no unanimity about the best management of tumor smaller than 2 cm. The risks of under/overtreatment should be carefully evaluated with the patient and balanced with the potential morbidities related to surgery. The importance of the Ki-67 index as a prognostic factor is still debated as well. Whenever technically feasible, parenchyma-sparing surgeries lead to the best chance of organ preservation. Lymphadenectomy seems to be another important prognostic issue and, according to recent findings, should be performed in noninsulinoma patients. In the case of enucleation of the lesion, a lymph nodal sampling should always be considered. The relatively recent introduction of minimally invasive techniques (robotic) is a valuable option to deal with these tumors. The current management of PanNETs is analysed throughout the many available published guidelines and evidences with the aim of helping clinicians in the difficult decision-making process.
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spelling pubmed-60816032018-08-23 Current Management of Pancreatic Neuroendocrine Tumors: From Demolitive Surgery to Observation Bartolini, Ilenia Bencini, Lapo Risaliti, Matteo Ringressi, Maria Novella Moraldi, Luca Taddei, Antonio Gastroenterol Res Pract Review Article Incidental diagnosis of pancreatic neuroendocrine tumors (PanNETs) greatly increased in the last years. In particular, more frequent diagnosis of small PanNETs leads to many challenging clinical decisions. These tumors are mostly indolent, although a percentage (up to 39%) may reveal an aggressive behaviour despite the small size. Therefore, there is still no unanimity about the best management of tumor smaller than 2 cm. The risks of under/overtreatment should be carefully evaluated with the patient and balanced with the potential morbidities related to surgery. The importance of the Ki-67 index as a prognostic factor is still debated as well. Whenever technically feasible, parenchyma-sparing surgeries lead to the best chance of organ preservation. Lymphadenectomy seems to be another important prognostic issue and, according to recent findings, should be performed in noninsulinoma patients. In the case of enucleation of the lesion, a lymph nodal sampling should always be considered. The relatively recent introduction of minimally invasive techniques (robotic) is a valuable option to deal with these tumors. The current management of PanNETs is analysed throughout the many available published guidelines and evidences with the aim of helping clinicians in the difficult decision-making process. Hindawi 2018-07-22 /pmc/articles/PMC6081603/ /pubmed/30140282 http://dx.doi.org/10.1155/2018/9647247 Text en Copyright © 2018 Ilenia Bartolini et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
Bartolini, Ilenia
Bencini, Lapo
Risaliti, Matteo
Ringressi, Maria Novella
Moraldi, Luca
Taddei, Antonio
Current Management of Pancreatic Neuroendocrine Tumors: From Demolitive Surgery to Observation
title Current Management of Pancreatic Neuroendocrine Tumors: From Demolitive Surgery to Observation
title_full Current Management of Pancreatic Neuroendocrine Tumors: From Demolitive Surgery to Observation
title_fullStr Current Management of Pancreatic Neuroendocrine Tumors: From Demolitive Surgery to Observation
title_full_unstemmed Current Management of Pancreatic Neuroendocrine Tumors: From Demolitive Surgery to Observation
title_short Current Management of Pancreatic Neuroendocrine Tumors: From Demolitive Surgery to Observation
title_sort current management of pancreatic neuroendocrine tumors: from demolitive surgery to observation
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6081603/
https://www.ncbi.nlm.nih.gov/pubmed/30140282
http://dx.doi.org/10.1155/2018/9647247
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