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Der Chirurg

, Volume 89, Issue 6, pp 422–427 | Cite as

Chirurgisches Vorgehen bei kleinen sporadischen neuroendokrinen Pankreastumoren

  • K. Holzer
Leitthema
  • 332 Downloads

Zusammenfassung

Kleine (<2 cm) sporadische neuroendokrine Pankreasneoplasien (pNENs) werden in funktionell aktive Tumoren und nichtaktive Tumoren unterteilt. Funktionell aktive pNENs setzen unterschiedliche Hormone wie Insulin, Gastrin, Glukagon oder vasoaktives intestinales Hormon frei und führen so, unabhängig von ihrer Größe, zu schweren Symptomen wie z. B. zu Hypoglykämie, Koma (Insulinom), Durchfällen (Gastrinom, Vipoma), Magen-Darm-Ulzera (Gastrinom) und Hyperglykämien (Glukagonom). Die asymptomatischen nichtaktiven pNENs verursachen kein hormonelles Syndrom, obwohl diese Tumoren in der Immunhistochemie eine Positivität für unterschiedliche Hormone und neuroendokrine Marker (z. B. Chromogranin oder Synaptophysin) aufweisen können. Nichtaktive kleine pNENs werden heute durch den breiten Einsatz der Schnittbildgebung deutlich häufiger gefunden und werden auch inzidentelle pNENs genannt. Die aktuellen Therapiealgorithmen der kleinen aktiven und nichtaktiven pNENs sind sehr unterschiedlich und beinhalten neben einer aktiven Überwachung (Wait-and-see-Strategie) nichtaktiver pNENs (G1, „low G2“) alle minimal-invasiven, roboterassistierten und offenen Techniken der Pankreasresektionen. Die existierenden chirurgischen und nichtchirurgischen Therapieempfehlungen begründen sich bis heute zumeist auf retrospektive Daten.

Schlüsselwörter

Wait-and-see-Strategie Enukleation Roboterassistenz Laparoskopie Lymphknotendissektion 

Surgical strategies for small sporadic neuroendocrine pancreatic tumors

Abstract

Small (<2 cm) sporadic neuroendocrine pancreatic neoplasms (pNENs) are a heterogeneous group of neoplasms, which can be separated into functionally active or non-functional tumors. Functionally active pNENs release various hormones, such as insulin, gastrin, glucagon and vasoactive intestinal hormones and therefore lead to severe symptoms independent of their size. The main symptoms include hypoglycemia, coma (insulinoma), diarrhea (gastrinoma, VIPoma), intestinal ulcers (gastrinoma) and hyperglycemia (glucagonoma). Asymptomatic inactive pNENs do not cause a hormonal syndrome even though in immunohistochemistry they are positive for various hormones and endocrine markers (e.g. chromogranin and synaptophysin). Non-active small pNENs are increasingly being found because of the widespread use of high-resolution imaging and are named incidental pNENs. The current therapy algorithms of small functionally active and non-functional pNENs are very different and include besides non-operative management and surveillance (wait and see strategy) of non-active pNENs (G1, low G2), all minimally invasive, open and robotic techniques of pancreas resection. Until today almost all recommendations of surgical and nonsurgical therapy algorithms have been established based on retrospective data.

Keywords

Wait and see strategy Enucleation Robotic assistance Laparoscopy Lymph node dissection 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

K. Holzer gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von der Autorin durchgeführte Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Sektionsleitung Endokrine Chirurgie, Klinik für Viszeral‑, Thorax- und GefäßchirurgieUniversitätsklinikum MarburgMarburgDeutschland

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