Surgery Versus Observation for Asymptomatic Nonfunctioning Pancreatic Neuroendocrine Tumors

  • Carlos R. Cordón-Fernández
  • Miguel F. Herrera
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)


Non-functioning pancreatic neuroendocrine tumors account for 2% of all pancreatic malignancies, most of them are benign and sporadic. The most common image studies for their characterization are CT, MRI, endoscopic ultrasound, and PET. Serum Chromogranine A is the most common tumor marker for PNETs and it is used for the diagnosis as well as for surveillance. Surgical resection, either open or laparoscopic is the treatment of choice for all symptomatic sporadic tumors as well as for malignant tumors in the absence of extra pancreatic extension, lymph node or hepatic metastases.


Non-functioning PNET CT MRI Endoscopic ultrasound PET Chromogranine A 


  1. 1.
    Massironi S, Sciola V, Peracchi M, Ciafardini C, Spampatti MP, Conte D. Neuroendocrine tumors of the gastro-entero-pancreatic system. World J Gastroenterol. 2008;14(35):5377–84.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Kulke MH, Anthony LB, Bushnell DL, de Herder WW, Godsmith SJ, Klimstra DS, et al. NANETS treatment guidelines: well-differenciated neuroendocrine tumors of the stomach and pancreas. Pancreas. 2010;39(6):735–52.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Franko J, Weantao F, Genovese E, Moser J. Non functional neuroendocrine carcinoma of the páncreas: incidence, tumor biology and outcomes in 2158 patients. J Gastrointest Surg. 2009;14(3):541–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Herrera MF, Akerstrom G, Angelos P, Grant CS, Hoff AO, Pantoja JP, et al. AACE/ACE disease state clinical review: pancreatic neuronedocrine incidentalomas. Endocr Pract. 2015;21:546–53.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Yao JC, Hassan M, Phan A, et al. One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol. 2008;26(18):3063.CrossRefPubMedGoogle Scholar
  6. 6.
    Kent RB, Van Heerden JA, Weiland LH. Nonfuctionning islet cell tumors. Ann Surg. 1981;193:185–90.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Bilimoria KY, Tomlinson JS, Merkow RP. Clinocopathologic features and treatment trends of pancreatic neuroendocrine tumors: analysis of 9821 patients. J Gastrointest Surg. 2007;11:1460–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Falconi M, Barstsch DF, Eriksson B, et al. ENETS concensus guidelines for the management of patients with digestive neuroendocrine neoplasm of the digestive system: well differenciated pancreatic non-functionning tumors. Neuroendocrinology. 2012;95:120–34.CrossRefPubMedGoogle Scholar
  9. 9.
    Halfdanarson TR, Rabe KG, Rubin J, et al. Pancreatic neuroendocrine tumors (PNETs): incidence, prognosis and recent trend toward improved survival. Ann Oncol. 2008;19(10):1727–33.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Yan M, Zeng L, Zhang Y, et al. Surgical treatment and clinical outcomes of nonfunctional pancreatic neuroendocrine tumors. A 14 year experience from a single center. Medicine. 2014;93(22):1–7.Google Scholar
  11. 11.
    Klimstra DS, Modlin IR, Coppola D, et al. The pathologic classification of neuroendocrine tumors: a review of nomenclature, grading, and staging systems. Pancreas. 2010;39:707–12.Google Scholar
  12. 12.
    Gullo L, Migliori M, Falconi M, et al. Nonfunctioning pancreatic tumors: a multicenter clínical study. Am J Gastroent. 2003;98(11):2435–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Phan GQ, Yeo CJ, Hruban RH, et al. Surgical experience with pancreatic and peripancreatic neuroendocrine tumors: review of 125 patients. J Gastrointest Surg. 1998;2(5):473–82.CrossRefPubMedGoogle Scholar
  14. 14.
    Kuo J, Lee J, Chabot J. Nonfunctional pancreatic neuroendocrine tumors. Surg Clin North Am. 2014;94(3):689–708.CrossRefPubMedGoogle Scholar
  15. 15.
    Kartalis N, Pozzi RM, Sundin A. Recent developments in imaging of pancreatic neuroendocrine tumors. Ann Gastroenterol. 2015;28(2):193–202.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Hochwald S, Conlon K, Brennan M. Nonfunctional pancreatic islet cell tumors. In: Doherty G, Skogseid B, editors. Surgical endocrinology. Philadelphia: Lippincot Williams &Wilkins; 2001. p. 362–73.Google Scholar
  17. 17.
    Sundin A, Vullierme MP, Kaltsas G, et al. ENETS consensus guidelines for the standards of care in neuroendocrine tumors: radiological examinations. Neuroendocrinology. 2009;90(2):167–83.CrossRefPubMedGoogle Scholar
  18. 18.
    Chatzipantelis P, Salla C, Konstantinou P, et al. Endoscopic ultrasound-guided fine-needle aspiration cytology of pancreatic neuroendocrine tumors: a study of 48 cases. Cancer. 2008;114(4):255–62.CrossRefPubMedGoogle Scholar
  19. 19.
    Miderer M, Weber MM, Fottner C. Molecular imaging of gastroenteropancreatic neuroendocrine tumors. Gastroenterol Clin N Am. 2010;39:923–35.CrossRefGoogle Scholar
  20. 20.
    Ter-Minassian M, Chan J, Hooshmand S, et al. Clinial presentation, survival and recurrence in patients with neuroendocrine tumors: results from a prospective institutional database. Endocr Relat Cancer. 2013;20:187–96.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Bettini R, Boninsegna L, Mantovani W, et al. Prognostic factors at diagnosis and value of WHO classification in a mono-institutional series of 180 non functioning pancreatic endocrine tumors. Ann Oncol. 2008;19:903–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Touzios JG, Kiely JM, Pitt SC, et al. Neuroendocrine hepatic metastases: does aggressive management improve survival? Ann Surg. 2005;241:776–85.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Lee LC, Grant CS, Salomao DR, et al. Small, nonfunctioning, asymptomatic pancreatic neuroendocrine tumors (PNETs): role of non-operative management. Surgery. 2012;152:965–74.CrossRefPubMedGoogle Scholar
  24. 24.
    Sallinen V, Haglund C, Sepannen H. Outcomes of resected nonfunctional pancreatic neuroendocrine tumors: do size and symptoms matter? Surgery. 2015;158(6):1556–63.CrossRefPubMedGoogle Scholar
  25. 25.
    Gaujoux S, Partelli S, Maire F, et al. Observational study of natural history of small sporadic nonfuntioning pancreatic neuroendocrine tumors. J Clin Endocrinol Metab. 2013;98(12):4784–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Zhang IY, Fernandez-del Castillo C, Zhao J, et al. Operative vs. non-operative management of nonfunctioning pancreatic neuroendocrine tumors. In: 49th annual meeting of the pancreas club syllabus. 2015. p. S001.Google Scholar
  27. 27.
    Falconi M, Plockinger U, Kwekkemboom D, et al. Well differenciated pancreatic nonfunctioning tumors/carcinoma, ENETS guidelines. Neuroendocrinology. 2006;84:196–211.CrossRefPubMedGoogle Scholar
  28. 28.
    Kim MJ, Choi DW, Heo JS, et al. Surgical strategies for nonfunctioning pancreatic neuroendocrine tumors. Br J Surg. 2012;99:1562–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Sharpe SM, In H, Winchester DJ, Talamonti MS, et al. Surgical resection provides an overall survival benefit for patients with small pancreatic neuroendocrine tumors. J Gastrointest Surg. 2015;19:117–23.CrossRefPubMedGoogle Scholar
  30. 30.
    Solorzano CC, Lee JE, Pisters PWT, et al. Nonfunctioning islet cell carcinoma of the páncreas: survival results in a contemporary series of 163 patiens. Surgery. 2011;130:1078–85.CrossRefGoogle Scholar
  31. 31.
    Toumpanakis C, Meyer T, Caplin ME. Citotoxic treatment including embolization/chemoembolization for neuroendocrine tumors. Best Pract Res Clin Endocrinol Metab. 2007;21:131.CrossRefPubMedGoogle Scholar
  32. 32.
    Moertel CG, Lefkopoulo M, Lipsitz S, et al. Streptozocina-doxorubicina, streptozocina-fluoracil or chlorozotocina in the treatment of advanced islet cell carcinoma. N Engl J Med. 1992;326:519–23.CrossRefPubMedGoogle Scholar
  33. 33.
    Moertel CG, Kvols LK, Oconnell MJ, et al. Treatment of neuroendocrine carcinoma with combined etoposide and cisplatin. Cancer. 1991;68:227.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Carlos R. Cordón-Fernández
    • 1
  • Miguel F. Herrera
    • 2
  1. 1.Department of Surgical OncologyInstituto Guatemalteco de Seguridad SocialGuatemala CityGuatemala
  2. 2.UNAM at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico

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