Surgical treatment of non-functional pancreatic neuroendocrine neoplasms / 中国实用外科杂志

ABSTRACT

The incidence of non-functional pancreatic neuroendocrine neoplasms(NF-pNENs)constantly increases due to the development of imaging techniques and the popularity of routine medical examination.WHO classification system,ENETS and AJCC grading systems,widely used in clinical practice,are independent prognostic factors.According to the G grading system,NF-pNENs are classified into benign,low-grade malignant and high-grade malignant tumors.Operative indications and treatments are absolutely different for each subgroup.Lymph node metastasis closely correlates with the position and size of tumor,lymphovascular invasion and Ki-67 index.Pre-operative determination of the presence of lymph node metastasis provides significant instructions for the choice of surgery since it indicates early tumor relapse and metastasis.The advance of ultrasoundguide biopsy provides more sensitive indictors for preoperative pathological grade and lymph node metastasis.Both domestic and foreign guidelines consider the tumor size as the critical factors for surgery.For those NF-pNENs2 cm,even with local vascular and organs invasion,a routine pancreatic surgery is recommended(distal pancreatectomy or pancreatic duodenectomy according to the tumor position).Lymph node sampling or regional lymphadenectomy should be routinely performed during surgeries.For those with liver metastasis,surgical resection,locoregional ablative therapy or liver transplantation is suggested according to the situation of metastatic sites.