Surgical treatment of non‐functioning pancreatic islet cell tumors

Abstract

Pancreatic endocrine tumors (PETs) are rare neoplasms originating from the amine precursor uptake and decarboxylation (APUD) stem cells. Although the majority of PETs are sporadic, they frequently occur in familial syndromes. PETs may cause a variety of functional syndromes or symptoms of local progression if they are non-functional. General neuroendocrine tumor markers are highly sensitive in the diagnostic assessment of a PET. Imaging studies for tumor localization and staging include computer tomography (CT) scan, magnetic resonance imaging (MRI), In(111)-octreotide scan, MIBG, and endoscopic ultrasonography (EUS). Treatment of PETs often requires a multi-modality approach; however, surgical resection remains the only curative therapy for localized (non-metastatic) disease. Treatment of metastatic disease includes biologic agents, cytotoxic chemotherapy, and liver-directed therapies.

TNM stage and grade in predicting the prognosis of operated, non‐functioning neuroendocrine carcinoma of the pancreas—a single‐institution experience

“…Most authors, however, have made this distinction [5,6,7,9,[22][23][24][25][26][27][28][29][30][31] and have agreed that histological differentiation has significant effect on prognosis. Eight of these authors have presented incidence data of poorly differentiated carcinomas (8-21%) [5,6,7,9,17,27,28,31].…”

Clinicopathological Features of Patients with Concomitant Intraductal Papillary Mucinous Neoplasm of the Pancreas and Pancreatic Endocrine Neoplasm

“…This assumption is supported by several observations. Firstly, the median age of the 10 patients was 62 years which corresponded to the average age of patients with IPMN (65 years) [10] and was significantly older than for patients with non-functioning PEN (40-50 years) [11] . Secondly, all the endocrine neoplasms were small (median size 14 mm) and thirdly, none of the endocrine neoplasms were hormonally active.…”

Neuroendocrine tumor disease: an evolving landscape

“…Patients with Ki-67 !2% have a 5-year survival rate of 80% compared with 40% for those with Ki-67 O2% (Ekeblad et al 2008). Results of surgery in PNENs with vascular involvement, of mainly the portal vein, are encouraging and surgery should also be considered for the treatment of LM (Bartsch et al 2000, Kouvaraki et al 2005, Akerstrom & Hellman 2009, Capurso et al 2011. In general, surgical approach is recommended in well-differentiated NENs (WHO groups I and II), whereas patients with poorly differentiated NEC (WHO group III) should primarily be treated with chemotherapy.…”

“…Data supporting the use of streptozotocin-based chemotherapy either with 5-FU and/or doxorubicin mainly come from older studies using a variety of nonstandard endpoints (Moertel et al 1992). Despite the limitations of the latter study, recent retrospective and small prospective studies have demonstrated the efficacy of this regimen with reports of tumor remissions of w40% (Kouvaraki et al 2005, Turner et al 2010. Smaller, phase II trials support the efficacy of temozolomide-based chemotherapy in PNENs (Kulke et al 2009).…”