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Kleine neuroendokrine Neoplasien des Pankreas

Early endocrine neoplasia of the pancreas

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Zusammenfassung

Neuroendokrine Neoplasien des Pankreas (pNEN) werden in den letzten 20 Jahren zunehmend häufiger diagnostiziert. In Abhängigkeit von der Funktionalität des Primärtumors, seiner Lokalisation, Größe und Proliferationsrate sollte die Indikation zu einer chirurgischen Therapie immer interdisziplinär für den individuellen Patienten festgelegt werden. Der Chirurg braucht ein profundes Wissen der Pathologie, Anatomie und Prognose des jeweiligen pNENs, um den optimalen Operationszeitpunkt und das adäquate Resektionsausmaß festzulegen. Der Evidenzgrad bezüglich des chirurgischen Therapieansatzes ist häufig gering, sodass die Erfahrung eines Experten/Zentrums für den Therapieerfolg von entscheidender Bedeutung ist. Der Beitrag stellt zusammengefasst die wichtigsten chirurgischen Therapieprinzipien bei der Behandlung kleiner T1-pNENs dar.

Abstract

Pancreatic endocrine neoplasias (pNENs) are uncommon but fascinating tumors with a rising incidence. In accordance to its location, size and grading, the decision to operate the patient should always be made in an interdisciplinary approach. This article provides a comprehensive review of the current literature addressing the current challenges in pNEN surgery and shows that patients with completely resected small pNENs generally have an excellent prognosis, but also that surveillance may be a powerful tool.

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Literatur

  1. Atema JJ, Jilesen AP, Busch OR, van Gulik TM, Gouma DJ, Nieveen van Dijkum EJ (2015) Pancreatic fistulae after pancreatic resections for neuroendocrine tumours compared with resections for other lesions. HPB (Oxford) 17:38–45

    Article  Google Scholar 

  2. Bartsch DK, Albers M, Knoop R, Kann PH, Fendrich V, Waldmann J (2013) Enucleation and limited pancreatic resection provide long-term cure for insulinoma in multiple endocrine neoplasia type 1. Neuroendocrinology 98:290–298

    Article  CAS  PubMed  Google Scholar 

  3. Baumann T, Rottenburger C, Nicolas G, Wild D (2016) Gastroenteropancreatic neuroendocrine tumours (GEP-NET) – Imaging and staging. Best Pract Res Clin Endocrinol Metab 30:45–57

    Article  PubMed  Google Scholar 

  4. Beger HG (2016) Surgical treatment of benign, premalignant and low-risk tumors of the pancreas: standard resection or parenchyma preserving, local extirpation. Chirurg 87:579–584

    Article  CAS  PubMed  Google Scholar 

  5. Bettini R, Partelli S, Boninsegna L, Capelli P, Crippa S, Pederzoli P, Scarpa A, Falconi M (2011) Tumor size correlates with malignancy in non-functioning pancreatic endocrine tumor. Surgery 150:75–82

    Article  PubMed  Google Scholar 

  6. Brient C, Regenet N, Sulpice L, Brunaud L, Mucci-Hennekine S, Carrère N, Milin J, Ayav A, Pradere B, Hamy A, Bresler L, Meunier B, Mirallié E (2012) Risk factors for postoperative pancreatic fistulization subsequent to enucleation. J Gastrointest Surg 16:1883–1887

    Article  PubMed  Google Scholar 

  7. Carrere N, Abid S, Julio CH, Bloom E, Pradere B (2007) Spleen-preserving distal pancreatectomy with excision of splenic artery and vein: a case-matched comparison with conventional distal pancreatectomy with splenectomy. World J Surg 31:375–382

    Article  PubMed  Google Scholar 

  8. Dedieu A, Rault A, Collet D, Masson B, Sa Cunha A (2011) Laparoscopic enucleation of pancreatic neoplasm. Surg Endosc 25:572–576

    Article  CAS  PubMed  Google Scholar 

  9. Diener MK, Seiler CM, Rossion I, Kleeff J, Glanemann M, Butturini G, Tomazic A, Bruns CJ, Busch OR, Farkas S, Belyaev O, Neoptolemos JP, Halloran C, Keck T, Niedergethmann M, Gellert K, Witzigmann H, Kollmar O, Langer P, Steger U, Neudecker J, Berrevoet F, Ganzera S, Heiss MM, Luntz SP, Bruckner T, Kieser M, Büchler MW (2011) Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial. Lancet 377:1514–1522

    Article  PubMed  Google Scholar 

  10. Eckhardt S, Schicker C, Maurer E, Fendrich V, Bartsch DK (2016) Robotic-assisted approach improves vessel preservation in spleen-preserving distal pancreatectomy. Dig Surg 33:406–413

    Article  PubMed  Google Scholar 

  11. Falconi M, Eriksson B, Kaltsas G, Bartsch DK, Capdevila J, Caplin M, Kos-Kudla B, Kwekkeboom D, Rindi G, Klöppel G, Reed N, Kianmanesh R, Jensen RT, Vienna Consensus Conference participants (2016) ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors. Neuroendocrinology 103:153–171

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Fendrich V, Bartsch DK (2016) Surgical approach of gastroduodenal neuroendocrine neoplasms. Chirurg 87:280–287

    Article  CAS  PubMed  Google Scholar 

  13. Fendrich V, Waldmann J, Bartsch DK, Langer P (2009) Surgical management of pancreatic endocrine tumors. Nat Rev Clin Oncol 6:419–428

    Article  PubMed  Google Scholar 

  14. Fernández-Cruz L, Molina V, Vallejos R, Jiménez Chavarria E, López-Boado MA, Ferrer J (2012) Outcome after laparoscopic enucleation for non-functional neuroendocrine pancreatic tumours. HPB (Oxford) 14:171–176

    Article  Google Scholar 

  15. Haug AR, Assmann G, Rist C (2012) Quantification of immunohistochemical expression of somatostatin receptors in neuroendocrine tumors using 68 Ga-DOTATATE PET/CT. Radiologe 50:349–354

    Article  Google Scholar 

  16. Heeger K, Falconi M, Partelli S, Waldmann J, Crippa S, Fendrich V, Bartsch DK (2014) Increased rate of clinically relevant pancreatic fistula after deep enucleation of small pancreatic tumors. Langenbecks Arch Surg 399:315–321

    Article  PubMed  Google Scholar 

  17. Hüttner FJ, Koessler-Ebs J, Hackert T, Ulrich A, Büchler MW, Diener MK (2015) Meta-analysis of surgical outcome after enucleation versus standard resection for pancreatic neoplasms. Br J Surg 102:1026–1036

    Article  PubMed  Google Scholar 

  18. Krautz C, Nimptsch U, Weber GF, Mansky T, Grützmann R (2017) Effect of hospital volume on in-hospital morbidity and mortality following pancreatic surgery in Germany. Ann Surg. https://doi.org/10.1097/SLA.0000000000002248

    Google Scholar 

  19. Lopez CL, Albers MB, Bollmann C, Manoharan J, Waldmann J, Fendrich V, Bartsch DK (2016) Minimally invasive versus open pancreatic surgery in patients with multiple endocrine neoplasia type 1. World J Surg 40:1729–1736

    Article  PubMed  Google Scholar 

  20. Maire F, Ponsot P, Debove C, Dokmak S, Ruszniewski P, Sauvanet A (2015) Endoscopic management of pancreatic fistula after enucleation of pancreatic tumors. Surg Endosc 29:3112–3116

    Article  PubMed  Google Scholar 

  21. Mathur A, Gorden P, Libutti SK (2009) Insulinoma. Surg Clin North Am 89:1105–1121

    Article  PubMed  PubMed Central  Google Scholar 

  22. Mauriello C, Napolitano S, Gambardella C, Candela G, De Vita F, Orditura M, Sciascia V, Tartaglia E, Lanza M, Santini L, Conzo G (2015) Conservative management and parenchyma-sparing resections of pancreatic neuroendocrine tumors: literature review. Int J Surg 21(Suppl 1):S10–S14

    Article  PubMed  Google Scholar 

  23. Mehrabi A, Hafezi M, Arvin J, Esmaeilzadeh M, Garoussi C, Emami G, Kössler-Ebs J, Müller-Stich BP, Büchler MW, Hackert T, Diener MK (2015) A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas: it’s time to randomize. Surgery 157:45–55

    Article  PubMed  Google Scholar 

  24. Partelli S, Cirocchi R, Crippa S, Cardinali L, Fendrich V, Bartsch DK, Falconi M (2017) Systematic review of active surveillance versus surgical management of asymptomatic small non-functioning pancreatic neuroendocrine neoplasms. Br J Surg 104:34–41

    Article  CAS  PubMed  Google Scholar 

  25. Partelli S, Bartsch DK, Capdevila J, Chen J, Knigge U, Niederle B, Nieveen van Dijkum EJ, Pape UF, Pascher A, Ramage J, Reed N, Ruszniewski P, Scoazec JY, Toumpanakis C, Kianmanesh R, Falconi M, all other Antibes Consensus Conference participants (2017) ENETS consensus guidelines for standard of care in neuroendocrine tumours: surgery for small intestinal and pancreatic neuroendocrine tumours. Neuroendocrinolgy 105(3):255–265. https://doi.org/10.1159/000464292

    Article  CAS  Google Scholar 

  26. La Rosa S, Klersy C, Uccella S (2009) Improved histologic and clinicopathologic criteria for prognostic evaluation of pancreatic endocrine tumors. Hum Pathol 40:30–40

    Article  PubMed  Google Scholar 

  27. Siech M, Bartsch D, Beger HG (2012) Indications for laparoscopic pancreas operations: results of a consensus conference and the previous laparoscopic pancreas register. Chirurg 83:247–253

    Article  CAS  PubMed  Google Scholar 

  28. Song KB, Kim SC, Hwang DW, Lee JH, Lee DJ, Lee JW, Jun ES, Sin SH, Kim HE, Park KM, Lee YJ (2015) Enucleation for benign or low-grade malignant lesions of the pancreas: single-center experience with 65 consecutive patients. Surgery 158:1203–1210

    Article  PubMed  Google Scholar 

  29. Srirajaskanthan R, Kayani I, Quigley AM (2010) The role of 68 Ga-DOTATATE PET in patients with neuroendocrine tumors and negative or equivocal findings on 111In-DTPA-octreotide scintigraphy. J Nucl Med 51:875–882

    Article  CAS  PubMed  Google Scholar 

  30. Strobel O, Cherrez A, Hinz U, Mayer P, Kaiser J, Fritz S, Schneider L, Klauss M, Büchler MW, Hackert T (2015) Risk of pancreatic fistula after enucleation of pancreatic tumours. Br J Surg 102:1258–1266

    Article  CAS  PubMed  Google Scholar 

  31. Tamburrino D, Spoletini G, Partelli S, Muffatti F, Adamenko O, Crippa S, Falconi M (2016) Surgical management of neuroendocrine tumors. Best Pract Res Clin Endocrinol Metab 30:93–102

    Article  PubMed  Google Scholar 

  32. Zhan Q, Deng XX, Han B, Liu Q, Shen BY, Peng CH, Li HW (2013) Robotic-assisted pancreatic resection: a report of 47 cases. Int J Med Robot 9:44–51

    Article  PubMed  Google Scholar 

  33. Zhao YP, Zhan HX, Zhang TP, Cong L, Dai MH, Liao Q, Cai LX (2011) Surgical management of patients with insulinomas: result of 292 cases in a single institution. J Surg Oncol 103:169–174

    Article  PubMed  Google Scholar 

  34. Zureikat AH, Moser AJ, Boone BA, Bartlett DL, Zenati M, Zeh HJ 3rd (2013) 250 robotic pancreatic resections: safety and feasibility. Ann Surg 258:554–559 (discussion 559–562)

    PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Klinik für Endokrine Chirurgie, Schön Klinik Hamburg Eilbek, Hamburg, Deutschland

    V. Fendrich

  2. Klinik für Visceral‑, Thorax- und Gefäßchirurgie, Standort Marburg, Universitätsklinikum Gießen und Marburg GmbH, Marburg, Deutschland

    D. K. Bartsch

Authors
  1. V. Fendrich
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  2. D. K. Bartsch
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Correspondence to V. Fendrich.

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Interessenkonflikt

V. Fendrich und D.K. Bartsch geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Fendrich, V., Bartsch, D.K. Kleine neuroendokrine Neoplasien des Pankreas. Chirurg 89, 266–273 (2018). https://doi.org/10.1007/s00104-017-0546-5

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